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Neil Resnick, M.D.

Neil Resnick, M.D.
Biography

Fred Rubin, M.D.

University of Pittsburgh Schools of the Health Sciences

Delirium Prevention Program At UPMC Helps Patients, Results In Quality Improvement And Bottom Line Savings, Study Shows

PITTSBURGH, June 29, 2006 — A coordinated program focused on preventing delirium in elderly hospital patients leads to marked improvements in their health outcomes, according to results from a University of Pittsburgh Medical Center (UPMC) study published in the current issue of the Journal of the American Geriatrics Society.

The study, led by Fred Rubin, M.D., professor of geriatric medicine at the University of Pittsburgh School of Medicine and chief of medicine at UPMC Shadyside, tracked more than 700 elderly patients admitted to one nursing unit over a 3.5 year period as part of an ongoing quality improvement initiative.

Delirious patients often experience agitation, hallucinations and a sharp decline in their attention and cognition. Conservative estimates suggest that 25 percent of patients age 70 and older are at risk for developing delirium, recognized as the single most common acute disorder affecting hospitalized adults. It adds both extra time and extra cost to hospital stays, immeasurable stress to the patient, family members and nursing staff and is associated with a hospital mortality rate ranging from 10 to 65 percent – equal to that of acute heart attack. Delirium is more likely to develop in older hospitalized patients who have had new medications added to their regimens, have been immobilized through the use of physical restraints, lost weight or are using bladder catheters.

In 2001, the UPMC Shadyside division of geriatrics implemented the delirium prevention program with the specific aim of improving the care of hospitalized older people. The program is based on the Hospital Elder Life Program (HELP) developed at Yale University, which demonstrated a reduction in the incidence of delirium at the Yale-New Haven Medical Center but had yet to be replicated in a community hospital setting prior to the UPMC Shadyside initiative.

“Our aim was to achieve the same positive results of our Yale colleagues, reducing the risks associated with hospitalization of our elderly patients,” said Dr. Rubin.

Dr. Rubin and colleagues collected data on delirium rates and costs of care during a one-year baseline period. They later compared the data to a study intervention period during which a HELP team, consisting of a supervising geriatrician, a nurse practitioner specializing in geriatrics and specifically trained volunteers, screened and evaluated all patients admitted to a general medical unit who were over age 70 for existing delirium and risk factors that might lead to delirium.

Those at immediate risk for developing delirium who had one or two risk factors (cognitive impairment, sleep deprivation, immobility, visual or hearing impairment and dehydration) but were not delirious received targeted daily interventions from the HELP team. The nurse practitioner advised staff nurses and treating physicians on matters that might precipitate delirium in these patients, including reducing the use of bladder catheters and medications with specific delirium-inducing side effects. HELP volunteers visited at-risk patients several times each day, aiming to socialize and orient them.

During the study period, the HELP intervention led to a 14.4 percent reduction in delirium that translates into an estimated 101 delirium cases that were prevented. Based on the prevented cases, savings to the hospital totaled more than $626,000 over six months. Additionally, significant improvements included increases in patient, family and nursing staff satisfaction.

The success of the HELP implementation at UPMC Shadyside has led to the program’s expansion in the hospital. HELP teams now offer intervention on four inpatient units with plans to expand the program to additional units.

“This program is a prime example of our commitment to delivering excellent care and to improving the patient experience at all levels,” said Loren Roth, M.D., senior vice president of quality care, UPMC.

“The value of this study is not only that it benefits patients and the health system, but also that it shows us at least one way to translate advances from research projects into improved care in the real world.” said Neil Resnick, M.D., chief of UPMC’s division of geriatric medicine and director of the University of Pittsburgh Institute on Aging.

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