Evaluation of a multicomponent pathway to address inpatient delirium on a neurosciences ward

Abstract

BackgroundDelirium is a frequent and detrimental complication of inpatient hospitalization. Multicomponent intervention in selected groups has been shown to prevent and treat delirium, though little data exists on the effect of intervention in neurological patients. We studied the efficacy of a multicomponent delirium care pathway implemented on a largely neurology and neurosurgery hospital ward among unselected patients.MethodsWe incorporated a multicomponent delirium care pathway into the workflow of a university hospital for patients older than 50 years. The pathway involved risk-stratification for development of delirium, delirium screening, and non-pharmacologic behavioral prevention and intervention. We then retrospectively reviewed admissions before and after implementation of the care pathway. Our primary endpoint was incidence of delirium; secondary endpoints included delirium days, length of stay, restraint use, readmission rates, and discharge disposition.ResultsSeven hundred ninety eight admissions from before the delirium care pathway went into effect and 797 admissions from afterwards were reviewed. Baseline characteristics between groups were similar. Delirium incidence between the two groups did not change (7.0% before vs 7.2% after, p = 0.89). Length of stay among delirious patients significantly decreased after implementation of the delirium care pathway (9.60 before vs 7.06 after, β = − 0.16, adjusted p-value = 0.001).ConclusionImplementation of a delirium care pathway on a neurosciences ward was not associated with changes in the rate of delirium development, though length of stay among delirious patients decreased. In a largely neurologic population, multicomponent intervention to prevent and treat delirium may not change delirium incidence, but may be effective in mitigating delirium complications.

Delirium in neurosurgery: a systematic review and meta-analysis

“…Six studies did not specify the number of patients undergoing craniotomy (i.e. requiring removal) [ 10 , 21 , 39 , 44 , 46 – 48 , 52 , 54 , 56 , 57 ]. Six studies did not report age, and seven studies did not report gender within the intracranial operated cohort [ 45 , 47 – 49 , 52 – 54 ].…”

“…A total of 4290 studies were screened on the title/abstract. Eventually, 47 studies were assessed full text, of which 27 excluded: delirium diagnosis not reproducible (n s (number of studies) = 9), [20][21][22][23][24][25][26][27][28] full text not found (n s = 3), [29][30][31] duplicate (n s = 3), [18,32] paediatric patients (n s = 1) [33], overlapping populations (n s = 3), [4,34,35] no delirium assessment (n s = 1), [36] no original data (n s = 2) [37,38] and an unclear number of patients undergoing intracranial surgery (n s = 5) [39][40][41][42][43]. Finally, 20 paper were included in the qualitative analysis and 18 papers in the quantitative analysis (n p (number of patients) = 5083).…”

“…Two RCTs, seven prospective and eleven retrospective cohort studies were included. Disease type for patients undergoing intracranial surgery were categorized in mixed (33.9%, n p = 1478), [4,10,21,32,39,[41][42][43][44][45][46][47][48] functional neurosurgery (26.8%, n p = 552), [11,46,[49][50][51] neurovascular (10.5%, n p = 145), [52][53][54] neuro-oncology (18.4%, n p = 1969) [5,7,55], traumatic brain injury (TBI) (4.3%, n p = 27) [56,57] and microvascular decompression (MVD) (6.2%, n p = 912) [9]. The mixed group included neurovascular, neuro-oncologic, TBI or hydrocephalus operations and functional neurosurgery (solely deep brain stimulation (DBS) in patients with Parkinson's disease).…”

Integrated care pathways in neurosurgery: A systematic review

“…We included 13 cohort studies with a control group and 11 case series without a control group. All 13 cohort studies [23][24][25][26][27][28][29][30][31][32][33][34][35], attained a score of 9 out of 11 on the JBI checklist for cohort studies (see S3 Table ), whilst 10 of the 11 case series [36][37][38][39][40][41][42][43][44][45][46], attained a full score of 10 on the JBI checklist for case series, with one study scoring 8 (S4 Table ). We observed that the majority of the primary studies (18 of 24 (75%)) included were published from year 2010 onwards.…”

Management of post-operative delirium following stereoelectroencephalography electrode placement for drug resistant epilepsy: Lessons learned from two case reports

“…Often expression of POD cannot be explained by a pre-existing disorder and can impair ability to comply with medical care [4] , [5] . Diagnosis and treatment are complicated by a multitude of interactions between pre-operative vulnerabilities with intra-operative and post-operative precipitating factors [6] , [7] .…”