title: A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients.
abstract: OBJECTIVE
  To investigate whether an education program and a reorganization of nursing and medical care improved the outcome for older delirious patients.
  
  
  METHODS
  Prospective intervention study.
  
  
  METHODS
  Department of General Internal Medicine, Sundsvall Hospital, Sweden.
  
  
  METHODS
  Four hundred patients, aged 70 and older, consecutively admitted to an intervention or a control ward.
  
  
  METHODS
  The intervention consisted of staff education focusing on the assessment, prevention, and treatment of delirium and on caregiver-patient interaction. Reorganization from a task-allocation care system to a patient-allocation system with individualized care.
  
  
  METHODS
  The patients were assessed using the Organic Brain Syndrome Scale and the Mini-Mental State Examination on Days 1, 3, and 7 after admission. Delirium was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.
  
  
  RESULTS
  Delirium was equally common on the day of admission at the two wards, but fewer patients remained delirious on Day 7 on the intervention ward (n=19/63, 30.2% vs 37/62, 59.7%, P=.001). The mean length of hospital stay+/-standard deviation was significantly lower on the intervention ward then on the control ward (9.4+/-8.2 vs 13.4+/-12.3 days, P<.001) especially for the delirious patients (10.8+/-8.3 vs 20.5+/-17.2 days, P<.001). Two delirious patients in the intervention ward and nine in the control ward died during hospitalization (P=.03).
  
  
  CONCLUSIONS
  This study shows that a multifactorial intervention program reduces the duration of delirium, length of hospital stay, and mortality in delirious patients.
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87 Umeå, Sweden. maria.lundstrom@germed.umu.se
authors.forename: Maria
authors.initials: M
authors.lastname: Lundström
authors.forename: Agneta
authors.initials: A
authors.lastname: Edlund
authors.forename: Stig
authors.initials: S
authors.lastname: Karlsson
authors.forename: Benny
authors.initials: B
authors.lastname: Brännström
authors.forename: Gösta
authors.initials: G
authors.lastname: Bucht
authors.forename: Yngve
authors.initials: Y
authors.lastname: Gustafson
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D003693:Delirium / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005851:Geriatric Nursing / Q000193:education*; D005853:Geriatrics / Q000193:education*; D017052:Hospital Mortality; D006801:Humans; D007318:Inservice Training; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009732:Nursing Care / Q000458:organization & administration; D010346:Patient Care Management / Q000458:organization & administration*; D015995:Prevalence; D011369:Professional-Patient Relations; D011446:Prospective Studies; D013548:Sweden / Q000453:epidemiology