title: Quality improvement and cost savings with multicomponent delirium interventions: replication of the Hospital Elder Life Program in a community hospital.
abstract: OBJECTIVE
  Delirium is a common problem associated with increased morbidity, mortality, and healthcare costs in the hospitalized elderly, yet there is little research outside of academic medical centers exploring methods to prevent its onset. The authors adapted the Hospital Elder Life Program (HELP) for use in a community hospital and assessed its impact on delirium rate, length of stay (LOS) and healthcare costs in elderly patients.
  
  
  METHODS
  Delirium episodes and duration, total patient-days with delirium and LOS were assessed in 595 patients 70 years of age or older admitted to a general medical floor at a community hospital. Pre-intervention outcomes were assessed on the medical floor for 4 months. Interventions adapted from HELP occurred over 9 months and included daily visits, therapeutic activities, and assistance with feeding, hydration, sleep, and vision/hearing impairment. Delirium was assessed on a daily basis with the Confusion Assessment Method (CAM).
  
  
  RESULTS
  The rate of episodes of delirium decreased from 20% in the pre-intervention group to 12% in the intervention group, a relative 40% reduction (P = 0.019). Total patients days with delirium decreased from 8% in the usual care group to 6% in the intervention group (P = 0.005). LOS among all patients enrolled in the intervention group decreased by 2 days (P < 0.001). Interventions resulted in $841,000 cost savings over 9 months.
  
  
  CONCLUSIONS
  HELP can be successfully adapted for implementation in a community hospital setting to decrease delirium episodes, total patient-days with delirium and LOS, and generate substantial cost savings.
authors.affiliation: Department of Psychiatry and Behavioral Health, Morristown Medical Center, Atlantic Health System, Morristown, NJ 07960, USA. thomas.zaubler@atlantichealth.org
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Zaubler
authors.forename: Kerry
authors.initials: K
authors.lastname: Murphy
authors.forename: Lori
authors.initials: L
authors.lastname: Rizzuto
authors.forename: Rachael
authors.initials: R
authors.lastname: Santos
authors.forename: Christine
authors.initials: C
authors.lastname: Skotzko
authors.forename: Jill
authors.initials: J
authors.lastname: Giordano
authors.forename: Rami
authors.initials: R
authors.lastname: Bustami
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017046:Cost Savings / Q000191:economics / Q000706:statistics & numerical data; D003693:Delirium / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000191:economics / Q000592:standards*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006764:Hospitals, Community; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D015397:Program Evaluation; D058996:Quality Improvement; D018709:Statistics, Nonparametric