A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients

Abstract

Objectives: To investigate whether an education program and a reorganization of nursing and medical care improved the outcome for older delirious patients.

Design: Prospective intervention study.

Setting: Department of General Internal Medicine, Sundsvall Hospital, Sweden.

Participants: Four hundred patients, aged 70 and older, consecutively admitted to an intervention or a control ward.

Intervention: The intervention consisted of staff education focusing on the assessment, prevention, and treatment of delirium and on caregiver-patient interaction. Reorganization from a task-allocation care system to a patient-allocation system with individualized care.

Measurements: The patients were assessed using the Organic Brain Syndrome Scale and the Mini-Mental State Examination on Days 1, 3, and 7 after admission. Delirium was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.

Results: Delirium was equally common on the day of admission at the two wards, but fewer patients remained delirious on Day 7 on the intervention ward (n=19/63, 30.2% vs 37/62, 59.7%, P=.001). The mean length of hospital stay+/-standard deviation was significantly lower on the intervention ward then on the control ward (9.4+/-8.2 vs 13.4+/-12.3 days, P<.001) especially for the delirious patients (10.8+/-8.3 vs 20.5+/-17.2 days, P<.001). Two delirious patients in the intervention ward and nine in the control ward died during hospitalization (P=.03).

Conclusion: This study shows that a multifactorial intervention program reduces the duration of delirium, length of hospital stay, and mortality in delirious patients.