Falls in A Tertiary Care Hospital—Association With Delirium: A Replication Study

Babine, Rhonda L.; Hyrkäs, Kristiina; Bachand, Deborah; Chapman, James E.; Fuller, Valerie J.; Honess, Cynthia; Wierman, Heidi R.

doi:10.1016/j.psym.2016.01.003

Cited by 24 publications

(17 citation statements)

References 26 publications

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“…The ndings of this clinical audit con rm the results of a number of observational studies (Sillner et al, 2019), and delirium prevention trials, that not only had shown an increased risk of falls among hospitalised patients with delirium, but a reduced risk of falling among delirium prevention intervention groups when compared to usual care (Hshieh et al, 2015a). Earlier work in this area had highlighted an association between falling and delirium in the hospital setting, but was limited to retrospective review of the clinical notes of patients who had fallen (Babine et al, 2016, Lakatos et al, 2009, or prospective observation of elderly patients cared for in the aged care setting. Importantly, this clinical audit has included a broad cross-sectional of adult acute inpatients and shown a strong relationship between an acute episode of delirium and risk of a subsequent fall.…”

Section: Discussionsupporting

confidence: 65%

“…Considering that most modern acute hospitals actively attempt to identify patients at the greatest risk of falls, and institute a number of interventions to prevent a fall, the conclusion reached by the Cochrane Review (quoted above) is quite sobering, and may indicate that only marginal gains may be obtained by implementation of further interventions to reduce falls in the acute hospital setting. It is for this reason, that we became interested in widening the scope of falls prevention when discovering the relationship between an episode of delirium in the hospital setting and a subsequent fall has been previously described (Babine et al, 2016, Lakatos et al, 2009, Sillner et al, 2019. However, previous work in this area was limited to retrospective review of the clinical notes of inhospital fallers, nding documented evidence of delirium prior to a fall, or some prospective studies of elderly patients in the hospital setting, among which an association between delirium and falls was observed (Basic and Hartwell, 2015, Mazur et al, 2016, Stenvall et al, 2007.…”

Section: Introductionmentioning

confidence: 99%

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World Delirium Awareness Day 2019, delirium and risk of falls in the hospital setting.

Shekhar

Chasle

Stott

et al. 2020

Preprint

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Background Delirium is an acute change in cognition, common among older hospitalized patients, however, patients of all ages are at risk of delirium during a hospital stay. The International Federation of Delirium Societies promotes, each year, a World Delirium Awareness Day , to raise the awareness of, not just recognizing delirium in the hospital setting, but ensuring interventions are in place to prevent the development of delirium. Hospitalized patients with delirium have increased risk of adverse events such as falls, pressure injury, malnutrition, increased length of stay, increased health care costs, and mortality. This clinical audit aimed to estimate the risk of a subsequent fall, following an acute episode of in-hospital delirium, across a broad cross-sectional of clinical settings.Methods Seventeen adult acute inpatient wards across the South Western Sydney, Local Health District, undertook an audit of the number of admitted patients who had had at least one episode of delirium since being admitted to hospital. Using the hospital-based incident management reporting system, the rates of subsequent falls was compared between delirium and non-delirium patients.Results Fifty of the 473 patients (11.4%) were identified by the nursing staff to have had at least one episode of delirium since admission. The proportion of fallers among the delirium and non-delirium patients were 10% and 2%, respectively (p = 0.004). The rate of falls per 1000 patient days was 6.45 (95% confidence interval (CI) 2.1 to 15.1) among delirium patients, compared to 2.12 (95% CI 1.0 to 4.0) among patients without delirium. The risk of falling among delirium patients was 4.25 higher compared to non-delirium patients (adjusted hazard ratio (HR) = 4.25, 95% CI 1.26 to 14.39).Conclusion This clinical audit has been able to show that an acute episode of delirium increases the risk of an in-hospital fall fourfold. Importantly, these results have highlighted the need for a hospital wide approach, to not just in identifying delirium, but the need to have interventions in place to reduce the risk of delirium. In other words, delirium prevention should be ‘core business’ of all nursing care, across the acute hospital setting.

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Section: Discussionsupporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

World Delirium Awareness Day 2019, delirium and risk of falls in the hospital setting.

Shekhar

Chasle

Stott

et al. 2020

Preprint

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“…Delirium is extremely common, affecting at least 15% of patients in acute hospitals, [3][4][5][6][7] and it is associated with many complications and poor outcomes. 4,[8][9][10][11][12][13][14][15] Delirium is both a marker of current dementia 4,[16][17][18] and associated with the acceleration of existing dementia. 19 In older patients without dementia, an episode of delirium strongly predicts future dementia risk.…”

Section: Delirium: Backgroundmentioning

confidence: 99%

The 4 ‘A’s test for detecting delirium in acute medical patients: a diagnostic accuracy study

MacLullich

Shenkin

Goodacre

et al. 2019

Health Technol Assess

102

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Background Delirium is a common and serious neuropsychiatric syndrome, usually triggered by illness or drugs. It remains underdetected. One reason for this is a lack of brief, pragmatic assessment tools. The 4 ‘A’s test (Arousal, Attention, Abbreviated Mental Test – 4, Acute change) (4AT) is a screening tool designed for routine use. This project evaluated its usability, diagnostic accuracy and cost. Methods Phase 1 – the usability of the 4AT in routine practice was measured with two surveys and two qualitative studies of health-care professionals, and a review of current clinical use of the 4AT as well as its presence in guidelines and reports. Phase 2 – the 4AT’s diagnostic accuracy was assessed in newly admitted acute medical patients aged ≥ 70 years. Its performance was compared with that of the Confusion Assessment Method (CAM; a longer screening tool). The performance of individual 4AT test items was related to cognitive status, length of stay, new institutionalisation, mortality at 12 weeks and outcomes. The method used was a prospective, double-blind diagnostic test accuracy study in emergency departments or in acute general medical wards in three UK sites. Each patient underwent a reference standard delirium assessment and was also randomised to receive an assessment with either the 4AT (n = 421) or the CAM (n = 420). A health economics analysis was also conducted. Results Phase 1 found evidence that delirium awareness is increasing, but also that there is a need for education on delirium in general and on the 4AT in particular. Most users reported that the 4AT was useful, and it was in widespread use both in the UK and beyond. No changes to the 4AT were considered necessary. Phase 2 involved 785 individuals who had data for analysis; their mean age was 81.4 (standard deviation 6.4) years, 45% were male, 99% were white and 9% had a known dementia diagnosis. The 4AT (n = 392) had an area under the receiver operating characteristic curve of 0.90. A positive 4AT score (> 3) had a specificity of 95% [95% confidence interval (CI) 92% to 97%] and a sensitivity of 76% (95% CI 61% to 87%) for reference standard delirium. The CAM (n = 382) had a specificity of 100% (95% CI 98% to 100%) and a sensitivity of 40% (95% CI 26% to 57%) in the subset of participants whom it was possible to assess using this. Patients with positive 4AT scores had longer lengths of stay (median 5 days, interquartile range 2.0–14.0 days) than did those with negative 4AT scores (median 2 days, interquartile range 1.0–6.0 days), and they had a higher 12-week mortality rate (16.1% and 9.2%, respectively). The estimated 12-week costs of an initial inpatient stay for patients with delirium were more than double the costs of an inpatient stay for patients without delirium (e.g. in Scotland, £7559, 95% CI £7362 to £7755, vs. £4215, 95% CI £4175 to £4254). The estimated cost of false-positive cases was £4653, of false-negative cases was £8956, and of a missed diagnosis was £2067. Limitations Patients were aged ≥ 70 years and were assessed soon after they were admitted, limiting generalisability. The treatment of patients in accordance with reference standard diagnosis limited the ability to assess comparative cost-effectiveness. Conclusions These findings support the use of the 4AT as a rapid delirium assessment instrument. The 4AT has acceptable diagnostic accuracy for acute older patients aged > 70 years. Future work Further research should address the real-world implementation of delirium assessment. The 4AT should be tested in other populations. Trial registration Current Controlled Trials ISRCTN53388093. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 40. See the NIHR Journals Library website for further project information. The funder specified that any new delirium assessment tool should be compared against the CAM, but had no other role in the study design or conduct of the study.

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“…Podatki o padcih v UKC Ljubljana kažejo, da je v letu 2016 padlo več moških (54,9 %) (Ferš, 2017). Ugotovitve glede starosti kažejo, da se ogroženost pacientov za padce s starostjo povečuje, kar potrjujejo tudi rezultati drugih avtorjev (Babine, et al, 2016;Kiel, 2016;Sardo, et al, 2016). Ugotovitve glede razlik v ogroženosti za padce na podlagi specialnosti oz.…”

Section: Diskusijaunclassified

Ogroženost za padce v terciarni bolnišnici

Gruden¹

2018

Obzor Zdrav Neg

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Uvod: Namen raziskave je bil ugotoviti, kakšna je ogroženost za padce odraslih pacientov v akutni zdravstveni obravnavi ter kakšne so razlike v ogroženosti glede na spol, starost, kraj pacientove obravnave (kliniko) in specialnost stroke ter kategorijo zahtevnosti bolnišnične zdravstvene nege.Metode: Uporabljeno je bilo kvantitativno raziskovanje – presečna opazovalna raziskava. Vzorec (n = 1361) je vključeval odrasle paciente, hospitalizirane v Univerzitetnem kliničnem centru Ljubljana. Podatki so se zbirali na za to posebej razvitem instrumentu, pri čemer je bila ogroženost za padce vrednotena z Morsejino lestvico. Podatki so se zbirali od oktobra do novembra 2015. Poleg osnovne deskriptivne statistike so bili uporabljeni tudi Mann-Whitneyjev test, test ANOVA in Pearsonov korelacijski test.Rezultati: Raziskava je pokazala, da je v akutni zdravstveni obravnavi v slovenski terciarni bolnišnici zmerno do visoko ogroženih za padce 69,1 % (n = 940) pacientov, od tega je 28,0 % (n = 381) visoko ogroženih. Ogroženost pacientov za padce je pozitivno povezana s starostjo (r = 0,462, p < 0,001). Razlikuje se tudi glede na kliniko (F = 29,210, p < 0,001), specialnost stroke (Z = –5,660, p < 0,001) ter kategorijo zahtevnosti zdravstvene nege (F = 125,464, p < 0,001).Diskusija in zaključek: Pomembno bolj ogroženi so starejši, pacienti, razvrščeni v višje kategorije zahtevnosti bolnišnične zdravstvene nege, ter pacienti, zdravljeni v okviru internističnih strok. Rutinsko ocenjevanje ogroženosti, načrtovanje in izvajanje ukrepov za preprečevanje padcev so temelji zmanjševanja padcev.

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Falls in A Tertiary Care Hospital—Association With Delirium: A Replication Study

Cited by 24 publications

References 26 publications

World Delirium Awareness Day 2019, delirium and risk of falls in the hospital setting.

World Delirium Awareness Day 2019, delirium and risk of falls in the hospital setting.

The 4 ‘A’s test for detecting delirium in acute medical patients: a diagnostic accuracy study

Ogroženost za padce v terciarni bolnišnici

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