Wednesday, November 2, 2011

Tackling Delirium in Hospitalized Patients with a Structured Approach

This is a great article in the New York Times by Susan Seliger about the hazards of delirium in hospitalized patients. Delirium in this setting is not uncommon, but is poorly understood and addressed by clinicians and organizations. Unfortunately it is fraught with perils for patients.

Fortunately, there are protocols and systems that can be implemented to reduce the likelihood of delirium.

Dr. Sharon Inouye, who is referenced in this article, helped to pioneer the HELP (Hospitalized Elder Life Program) that seeks to reduce delirium by increasing social interactions with hospitalized elders. The goal of this program is to return patients to home close to the functional capacity that they came in to the hospital with. One of the hospitals that I have worked with implemented this program very successfully.

Other strategies to improve delirium include reduction of the medications that can lead to delirium, improving ambulation, and attention to hearing, visual, and eating impairments.

Alcohol withdrawal - unfortunately also quite frequent in elders - is a fairly common cause of delirium in the hospitalized patient, and can be tended to with careful history-taking, as well as protocols for close monitoring.

Undiagnosed or untreated pain is often a common cause of delirium, which somehow continues to evade clinicians. Sometimes clinicians get stuck between the "rock and hard place" of treating the pain with narcotic medications which can then in turn also lead to delirium.

Ultimately, this "hospital acquired condition" can also be mitigated by taking a systematic, performance improvement oriented approach to identifying patients at risk, implementing strategies to reduce the risk, and monitoring outcomes closely to ensure that the intended interventions are indeed in place.

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