Randomized trial of a delirium abatement program for postacute skilled nursing facilities.
OBJECTIVE
To determine whether a delirium abatement program (DAP) can shorten duration of delirium in new admissions to postacute care (PAC).


METHODS
Cluster randomized controlled trial.


METHODS
Eight skilled nursing facilities specializing in PAC within a single metropolitan region.


METHODS
Four hundred fifty-seven participants with delirium at PAC admission.


METHODS
The DAP consisted of four steps: assessment for delirium within 5 days of PAC admission, assessment and correction of common reversible causes of delirium, prevention of complications of delirium, and restoration of function.


METHODS
Trained researchers screened eligible patients. Those with delirium defined according to the Confusion Assessment Method were eligible for participation using proxy consent. Regardless of location, researchers blind to intervention status re-assessed participants for delirium 2 weeks and 1 month after enrollment.


RESULTS
Nurses at DAP sites detected delirium in 41% of participants, versus 12% in usual care sites (P<.001), and completed DAP documentation in most participants in whom delirium was detected, but the DAP intervention had no effect on delirium persistence based on two measurements at 2 weeks (DAP 68% vs usual care 66%) and 1 month (DAP 60% vs usual care 51%) (adjusted P> or =.20). Adjusting for baseline differences between DAP and usual care participants and restricting analysis to DAP participants in whom delirium was detected did not alter the results.


CONCLUSIONS
Detection of delirium improved at the DAP sites, but the DAP had no effect on the persistence of delirium. This effectiveness trial demonstrated that a nurse-led DAP intervention was not effective in typical PAC facilities.
Marcantonio
Edward R
ER
Divisions of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02446, USA. emarcant@bidmc.harvard.edu
Bergmann
Margaret A
MA
Kiely
Dan K
DK
Orav
E John
EJ
Jones
Richard N
RN
D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003693:Delirium / Q000175:diagnosis / Q000451:nursing*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008609:Mental Status Schedule; D009730:Nursing Assessment; D009733:Nursing Diagnosis; D012866:Skilled Nursing Facilities; D016896:Treatment Outcome