Rate of delirium onset during hospitalization

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Delirium affects patient safety, patient experience, alternate level of care (ALC) rates, access, and flow. Delirium is associated with increased mortality in several care settings (emergency department, hospital care, and long-term care (LTC)) and prolonged length of stay in hospital (~8 days) (McCusker et al, 2003). Patients that develop delirium are 2.4 times more likely to be placed in LTC, which leads to longer wait times and a greater number of ALC days. Delirium is only recognized in about one-third of cases, so education and prevention strategies are critical to improving patient outcomes.

Key Resources

Delirium Quality Standard

The Alternate Level of Care (ALC) Leading Practices Guide: Preventing Hospitalization and Extended Stays for Older Adults

Provincial Geriatrics Leadership Ontario Quality Standard Implementation Guide

Delirium Senior Friendly Hospital Toolkit

sfCare E-Learning Series

Change Ideas

Exercise caution when prescribing certain medications (e.g., sedative-hypnotics, benzodiazepines, opioids)

Reduce or eliminate prescribing listed medications that are known to increase risk of hospital- acquired delirium (when appropriate)
GeriMedRisk
Choosing Wisely webinar on reducing prescribing of sedative-hypnotics
Choosing Wisely Canada: Drowsy Feeling Lousy Toolkit

Create a sleep-friendly environment

Create a sleep-friendly environment (e.g., staff education to offer culturally sensitive amenities to promote better sleep, reduce noise and lights, and engage patients and caregivers on education about sleep-friendly environment)
Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
Adjust nursing workflows and reschedule the administration of nonessential medication, so that patients are not unnecessarily disturbed during typical sleep hours (e.g., between 10 p.m. and 6 a.m.)
Have environmental services reduce overnight noise and lighting
The Impact of Environmental Risk Factors on Delirium and Benefits of Noise and Light Modifications: A Scoping Review

Adopt a diagnostic approach to identifying patients at high risk of acquiring delirium while in hospital

Typically, delirium is not the main reason for a patient's admission to an inpatient facility. Patients with hip fractures, cardiac disease, and COPD have an increased risk of hospital-acquired delirium.

Identify which patients are at higher risk of acquiring delirium while hospitalized and target risk mitigation strategies to prevent delirium onset
Ontario Health’s Hip Fracture Quality Standard and placemat (a quick reference resource that summarizes the quality standard and includes links to helpful resources and tools)
Incorporate quality standard recommendations (e.g., delirium screening and multimodal analgesia) when creating preoperative and postoperative order sets.
Osteoporosis Canada position paper on geriatric hip fracture care standards
Risk of Pre-and Post-Operative Delirium and the Delirium Elderly At Risk (DEAR) Tool in Hip Fracture Patients
Ontario Health’s Chronic Obstructive Pulmonary Disease Quality Standard and placemat (a quick reference resource that summarizes the quality standard and includes links to helpful resources and tools.

Reference

McCusker J, Cole MG, Dendukuri N, Belzile E. Does delirium increase hospital stay? J Am Geriatr Soc. 2003 Nov;51(11):1539–46.