Effect of a Comprehensive Inpatient Delirium Care Pathway on Incidence and Length of Stay (P6.196)

Objective: To determine the changes in the rate and clinical consequences of delirium before and after institution of a delirium care pathway on an inpatient neurosciences unit. Background: Delirium occurs frequently in neurology and neurosurgery patients and is associated with significant morbidity. Guidelines recommend multicomponent non-pharmacologic interventions to prevent delirium. However, studies examining the effect of such interventions in clinical practice with neuroscience patients are scant and have shown mixed results. Methods: We instituted a comprehensive delirium care pathway utilizing standardized risk-assessment at admission, routine screening by nursing staff, and a targeted multicomponent intervention for prevention and treatment on a neurosciences unit at a tertiary care medical center. To assess its impact, we conducted a before/after retrospective cohort study. Patients over 50 years old admitted the year preceding (n=474) and the year after (n=400) institution of the care pathway (Delirium Care Plan, DCP) were included. The primary outcome was incident delirium. Secondary outcomes included length of hospital stay, functional status and disposition at discharge, along with restraint and sitter use. Delirium was diagnosed by chart review using a previously validated methodology. Results: Incident delirium was 14.6[percnt] for patients admitted before and 12.2[percnt] for those admitted after the DCP (p=0.42). Among all patients with delirium, those admitted after the DCP had a shorter length of stay than those admitted before (9.33 versus 7.17 days, p=0.024; OR 0.12). This reduction was despite an increase in the average Charlson comorbidity index between the before and after groups. Differences in other secondary outcomes were not significant after DCP implementation. Conclusions: After incorporation of a comprehensive care pathway to address delirium in a neurosciences unit, we saw a trend towards a reduction in the incidence of delirium and a significant reduction in length of hospital stay among delirious patients. Disclosure: Dr. Brown has nothing to disclose. Dr. Josephson has received personal compensation in an editorial capacity for Journal Watch Neurology and Continuum. Dr. Anderson has nothing to disclose. Dr. Reid has nothing to disclose. Dr. Douglas has nothing to disclose.