Delirium in hospital predictive of readmission, discharge to post-acute care facilities, emergency department visits

New research shows that hospitalized patients with delirium are vulnerable in the early post-hospitalization period.

Delirium in hospital is a predictor of readmissionemergency room visits and discharge to a location other than home, recent search shows.

the development of delirium in hospital impacts about 12.5% ​​of general practice admissions and up to 81% of intensive care unit patients. Previous research has shown that delirium in hospitalized patients is predictive prolonged hospital stay, prolonged mechanical ventilation and mortality.

Recent research in the Journal of Hospital Medicine presented data collected from more than 700 delusional patients and nearly 8,000 non-delusional patients. Researchers found that delirious patients had increased risks of 30-day readmission, emergency room visits, and discharge from post-acute care facilities.

“These results suggest that patients with delirium are particularly vulnerable in the post-hospitalization period and are a key group to focus on reducing readmission rates and post-discharge health care utilization,” wrote Researchers.

Link between hospital delirium and readmissions

the Journal of Hospital Medicine the research builds on previous studies of in-hospital delirium, the research’s lead author said Health Leaders.

“Previous studies have shown that delirium is associated with functional decline at discharge, so these patients may be particularly vulnerable in the days and weeks after discharge from hospital. Our work helps confirm this because we show that patients who become delusional in hospital are far more likely to be readmitted within 30 days of discharge, compared to patients who do not develop delirium,” said Sara LaHue, MD, resident physician at the Department of Neurology, School of Medicine, University of California, San Francisco.

The new research indicates that hospital-based interventions should be targeted to delirious patients to reduce readmissions, she said. “Hospital-based interventions that reduce the development of delirium may then reduce complications of delirium, such as readmission.”

Reduce use of post-acute care services associated with delirium

To avoid delirium-related hospital readmissions, clinicians should work to prevent patients from becoming delusional in hospital, LaHue said.

“This may include systems for identifying patients at high risk for delirium, screening for active delirium, and implementing interventions that target the underlying cause to reduce the severity or duration of delirium. While such a program may take some work to get off the ground, the benefits to patients, their families and the hospital system can be significant.”

One member of the team that is often overlooked is the home carer, she said.

“Educating caregivers about risk factors for delirium can be very helpful – he or she can bring glasses or hearing aids from home, engage the patient in meaningful conversation to help orient them and encourage regulation sleep-wake cycles. If a patient becomes delusional, the caregiver can continue to assist with these interventions.”

Home caregivers are an essential component of post-acute care, LaHue said.

“We know that delirium is associated with functional decline at dumpto coordinate safe discharge plans with the caregiver, especially to identify resource needs – physiotherapy, occupational therapy, home healthand nursing – can potentially help reduce complications after discharge from hospital. »

Another crucial factor is follow-up care, she said. “It’s also important to follow up quickly with a primary care provider, who can assess any additional needs.”

Christopher Cheney is the Clinical Care Editor at HealthLeaders.

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