BackgroundDelirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients. However, in many other settings its prevalence and clinical consequences are understudied. The aims of this study were: (1) To assess delirium prevalence in a large, diverse cohort of acute care patients classified as either at risk or not at risk for delirium; (2) To compare these two groups according to defined indicators; and (3) To compare delirious with non-delirious patients regarding hospital mortality, ICU and hospital length of stay, nursing hours and cost per case.MethodsThis cohort study was performed in a Swiss university hospital following implementation of a delirium management guideline. After excluding patients aged < 18 years or with a length of stay (LOS) < 1 day, 29′278 patients hospitalized in the study hospital in 2014 were included.Delirium period prevalence was calculated based on a Delirium Observation Scale (DOS) score ≥ 3 and / or Intensive Care Delirium Screening Checklist (ICDSC) scores ≥4.ResultsOf 10′906 patients admitted, DOS / ICDSC scores indicated delirium in 28.4%. Delirium was most prevalent (36.2–40.5%) in cardiac surgery, neurosurgery, trauma, radiotherapy and neurology patients. It was also common in geriatrics, internal medicine, visceral surgery, reconstructive plastic surgery and cranio-maxillo-facial surgery patients (prevalence 21.6–28.6%). In the unadjusted and adjusted models, delirious patients had a significantly higher risk of inpatient mortality, stayed significantly longer in the ICU and hospital, needed significantly more nursing hours and generated significantly higher costs per case. For the seven most common ICD-10 diagnoses, each diagnostic group’s delirious patients had worse outcomes compared to those with no delirium.ConclusionsThe results indicate a high number of patients at risk for delirium, with high delirium prevalence across all patient groups. Delirious patients showed significantly worse clinical outcomes and generated higher costs. Subgroup analyses highlighted striking variations in delirium period-prevalence across patient groups. Due to the high prevalence of delirium in patients treated in care centers for radiotherapy, visceral surgery, reconstructive plastic surgery, cranio-maxillofacial surgery and oral surgery, it is recommended to expand the current focus of delirium management to these patient groups.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3345-x) contains supplementary material, which is available to authorized users.

Diaries are written for critically ill patients, to help them understand their intensive care stay and come to terms with their illness. The aim of this content analysis of eight such diaries is to understand the potential benefits for patients and families of this care intervention. A main category emerged: Sharing throughout the ICU time. Four themes were identified: (a) Sharing the story, (b) Sharing the presence, (c) Sharing feelings, and (d) Sharing through support. The first theme reflects the narration of daily events. The second is the perceived presence of health professionals and family at the patient's bedside and the presence of the patient as a person through the diary entries. The third theme describes the expression of feelings as written throughout the text. The last theme refers to the support offered to the patient. The diaries reflect the commitment and care of contributors to the patients' welfare.

Deficiencies in collaboration and communication between healthcare professionals have a negative impact on the provision of healthcare and on patient outcomes. Policymakers and healthcare managers, as well as clinicians and practitioners, are aware of this and have a growing interest in improving these relationships. To establish new models of care delivery, it is necessary to determine the interventions that are most effective in furthering interprofessional collaboration. This article provides an overview of the evidence base for interprofessional collaboration involving doctors and nurses and new models of care in relation to patient outcomes. Two authors conducted independent literature searches in PubMed, CINAHL, and Cochrane Library and selected fourteen randomised controlled trials (RCT) for review. All of the RCTs originated from Western countries, and the majority tested collaborative care management models against usual care within the elderly population. The major components of the interventions involved individual evidence-based treatment plans, care coordination, health status monitoring, coaching in self-management and promotion of community-based services. They varied between a few days' and three years' duration. Outcome measures incorporated mortality, clinical, functional and social outcomes, and utilisation of medical services. Some studies also used patient-reported outcomes. While the results of the fourteen RCTs included were mixed, all but one study reported at least one statistically significant improvement in outcome following interventions based on interprofessional collaboration. More rigorous research in this field and expansion of areas of interprofessional collaboration are needed. Nevertheless, up to now the evidence base of interprofessional collaboration shows promising results in relation to patient outcomes.