Objectives
To determine whether a bundled risk screening and warning or action card system improves formal delirium diagnosis and person-centered outcomes in hospitalized older adults.
Design
Prospective trial with sequential introduction of screening and interventional processes.
Setting
Two tertiary referral hospitals in Australia.
Participants
Individuals aged 65 and older presenting to the emergency department (ED) and not requiring immediate resuscitation (N = 3,905).
Intervention
Formal ED delirium screening algorithm and use of a risk warning card with a recommended series of actions for the prevention and management of delirium during the subsequent admission
Measurements
Delirium diagnosis at hospital discharge, proportion discharged to new assisted living arrangements, in-hospital complications (use of sedation, falls, aspiration pneumonia, death), hospital length of stay.
Results
Participants with a positive risk screen were significantly more likely (relative risk = 6.0, 95% confidence interval = 4.9–7.3) to develop delirium, and the proportion of at-risk participants with a positive screen was constant across three study phases. Delirium detection rate in participants undergoing the final intervention (Phase 3) was 12.1% (a 2% absolute and 17% relative increase from the baseline rate) but this was not statistically significant (P = .29), and a similar relative increase was seen over time in participants not receiving the intervention
Conclusion
A risk screening and warning or action card intervention in the ED did not significantly improve rates of delirium detection or other important outcomes.
from Journal of the American Geriatrics Society http://ift.tt/2tmbl1F
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