title: Development, Implementation, and Outcomes of a Delirium Protocol in the Surgical Trauma Intensive Care Unit.
abstract: BACKGROUND
  Delirium in the critically ill is associated with increased mortality, length of stay (LOS), and prolonged cognitive dysfunction. Existing guidelines provide no recommendation for use of combination nonpharmacological and pharmacological prevention protocols or use of antipsychotic medications for the prevention or treatment of delirium.
  
  
  OBJECTIVE
  This study evaluated the impact of implementing a delirium treatment protocol on the number of delirium-free days experienced by acutely delirious patients in the surgical trauma intensive care unit (STICU).
  
  
  METHODS
  This retrospective, institutional review board-approved, pre-implementation (PRE) versus post-implementation (POST) cohort evaluated delirious patients admitted to the STICU. Patients were evaluated based on the duration of delirium. Secondary end points included ICU LOS, amount of atypical and typical antipsychotic medication used, amount of analgesia and sedation used, and adverse drug events associated with antipsychotics.
  
  
  RESULTS
  Of the 593 evaluated, 89 patients were included (38 PRE vs 51 POST). Implementation of a delirium protocol reduced the number of delirious days, 8.2 ± 5.7 days PRE versus 4.5 ± 4.4 days POST; P = 0.001. ICU LOS in surviving patients and use of concomitant medications, intravenous morphine equivalents, and propofol were significantly reduced in the POST group.
  
  
  CONCLUSIONS
  The implementation of a delirium protocol with nonpharmacological and pharmacological interventions had an impact on STICU patients experiencing acute delirium by significantly increasing delirium-free days and reducing the ICU LOS, in addition to decreased administration of concomitant medications.
authors.affiliation: 1 New Hanover Regional Medical Center, Wilmington, NC, USA.
authors.forename: Danine
authors.initials: D
authors.lastname: Sullinger
authors.affiliation: 1 New Hanover Regional Medical Center, Wilmington, NC, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gilmer
authors.affiliation: 1 New Hanover Regional Medical Center, Wilmington, NC, USA.
authors.forename: Lesly
authors.initials: L
authors.lastname: Jurado
authors.affiliation: 1 New Hanover Regional Medical Center, Wilmington, NC, USA.
authors.forename: Lisa Hall
authors.initials: LH
authors.lastname: Zimmerman
authors.affiliation: 1 New Hanover Regional Medical Center, Wilmington, NC, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Steelman
authors.affiliation: 1 New Hanover Regional Medical Center, Wilmington, NC, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Gallagher
authors.affiliation: 1 New Hanover Regional Medical Center, Wilmington, NC, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Dupre
authors.affiliation: 1 New Hanover Regional Medical Center, Wilmington, NC, USA.|2 University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Acquista
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D003693:Delirium / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000601:surgery*
chemical_list: D000700:Analgesics; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives
keywords: adult medicine; analgesia; antipsychotics; antipsychotics (atypical); critical care; outcomes research/analysis; preventive medicine; sedatives; surgery; trauma