title: A delirium risk modification program is associated with hospital outcomes.
abstract: BACKGROUND
  Delirium has been associated with negative health consequences, which can potentially be improved by delirium risk modification. This study sought to determine if a quality improvement project to identify and modify delirium risk and discharge to rehabilitation is associated with improved outcomes for patients and health care systems.
  
  
  METHODS
  In older veterans admitted to a tertiary VA hospital, delirium risk was assessed using cognitive impairment, vision impairment, and dehydration. Delirium risk was communicated to providers via electronic medical record. To modify delirium risk, interventions were provided in cognitive stimulation, sensory improvement, and sleep promotion. Primary outcomes included length of stay, restraint use, discharge to rehabilitation, and hospital variable direct costs. Outcomes were compared using a propensity-matched cohort of patients without intervention. Number of intervention categories was compared with primary outcomes.
  
  
  RESULTS
  Patients (n = 1527) were older (78.2 ± 8.3 years) and male (98%). Propensity-matched patients (n = 566) were well matched for age, gender, cognitive deficits, vision impairment, and dehydration. Patients with interventions were discharged to rehabilitation similarly (mean difference [MD] 2.2%, 95% CI -2.5-6.9) and had lower lengths of stay (MD -0.7 day, 95% CI -1.3 to -0.1), lower restraint use (MD -4.0%, 95% CI -6.7 to -1.2) and trended toward lower variable direct costs (MD -$1390, 95% CI -3586-807). Increasing number of interventions was associated with shorter length of stay, lower rate of restraint use, and lower variable direct costs.
  
  
  CONCLUSIONS
  This delirium risk modification project was associated with patient outcomes and reduced costs. Serious consideration should be given to delirium risk identification and modification programs.
authors.affiliation: Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA; Division of Aging, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: jrudolph@partners.org.
authors.forename: James L
authors.initials: JL
authors.lastname: Rudolph
authors.affiliation: Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Archambault
authors.affiliation: Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA; School of Nursing, Science, and Health Professions, Regis College, Boston, MA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Kelly
mesh_terms: D000368:Aged; D003693:Delirium / Q000517:prevention & control*; D005260:Female; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Delirium; aged; health care cost; prevention; rehabilitation; risk stratification