• Sara C LaHue, Judy Maselli, Stephanie Rogers, Julie Casatta, Jessica Chao, Rhiannon Croci, Ralph Gonzales, Brian Holt, S Andrew Josephson, Sudha Lama, Catherine Lau, Charles McCulloch, John C Newman, Mark Terrelonge, Jan Yeager, and Vanja C Douglas.
• Department of Neurology, School of Medicine, University of California, San Francisco, California.
• J Hosp Med. 2021 Jul 1; 16 (7): 397403397-403.

BackgroundDelirium is associated with poor clinical outcomes that could be improved with targeted interventions.ObjectiveTo determine whether a multicomponent delirium care pathway implemented across seven specialty nonintensive care units is associated with reduced hospital length of stay (LOS). Secondary objectives were reductions in total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use.MethodsThis retrospective cohort study included 22,708 hospitalized patients (11,018 preintervention) aged ≥50 years encompassing seven nonintensive care units: neurosciences, medicine, cardiology, general and specialty surgery, hematology-oncology, and transplant. The multicomponent delirium care pathway included a nurse-administered delirium risk assessment at admission, nurse-administered delirium screening scale every shift, and a multicomponent delirium intervention. The primary study outcome was LOS for all units combined and the medicine unit separately. Secondary outcomes included total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use.ResultsAdjusted mean LOS for all units combined decreased by 2% post intervention (proportional change, 0.98; 95% CI, 0.96-0.99; P = .0087). Medicine unit adjusted LOS decreased by 9% (proportional change, 0.91; 95% CI, 0.83-0.99; P = .028). For all units combined, adjusted odds of 30-day readmission decreased by 14% (odds ratio [OR], 0.86; 95% CI, 0.80-0.93; P = .0002). Medicine unit adjusted cost decreased by 7% (proportional change, 0.93; 95% CI, 0.89-0.96; P = .0002).ConclusionThis multicomponent hospital-wide delirium care pathway intervention is associated with reduced hospital LOS, especially for patients on the medicine unit. Odds of 30-day readmission decreased throughout the entire cohort.

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