These indices are effective methods to incorporate the influence of comorbid conditions in models designed to assess the risk of in-hospital mortality and readmission using administrative data with limited clinical information, especially when small samples sizes are an issue.

delirium was associated with higher levels of frailty: the identification of frail patients may help to target those at a greatest risk of delirium. Survival following delirium was poor with the combination of frailty and delirium conferring a particularly bleak prognosis.

Delirium is associated with high rates of institutionalisation and an increased risk of death up to 5 years after index event. Prior to delirium, individuals seem to compensate for their vulnerability. The impact of delirium itself, directly or indirectly, may convert vulnerability into adverse outcome.

A large veteran's hospital participated in a year-long collaborative project across 9 hospitals to reduce serious injury from falls in acute care, targeting medical-surgical units. The primary objective of this project was to develop and test a set of interventions (bundles) to prevent serious physical injury (fractures and hemorrhagic bleeds) from patient falls. The interventions were implemented using tests of change on 2 medical-surgical units focused on engaging unit-based staff and combining innovations for vulnerable populations at greatest risk for injury if they fall.

Delirium is a common disorder in ill older patients, characterized by a fluctuating disturbance of consciousness and changes in cognition that develop over a short period of time. Studies have shown that delirium is an independent predictor of increased length of hospital stay, and is associated with increased dependency and mortality, as well as being distressing for patients and families. Much is known about the epidemiology of delirium, including predisposing factors such as pre-existing dementia and advanced age, and common precipitants such as infection, drugs and major surgery. In comparison, very little is known about the neuropathological mechanisms that lead to the development of delirium.

Plasma esterase activities are suppressed during delirium. These data reinforce the need for extreme caution with drugs in this vulnerable population.

Falls and fall injuries in hospitals are the most frequently reported adverse event among adults in the inpatient setting. Advancing measurement and improvement around falls prevention in the hospital is important as falls are a nurse sensitive measure and nurses play a key role in this component of patient care. A framework for applying the concepts of high reliability organizations to falls prevention programs is described, including discussion of the core characteristics of such a model and determining the impact at the patient, unit, and organizational level. This article showcases the components of a patient safety culture and the integration of these components with fall prevention, the role of nurses, and high reliability.

No abstract