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Falls in the general hospital: association with delirium, advanced age, and specific surgical procedures.

Psychosomatics. 2009 May-Jun;50(3):218-26

Authors: Lakatos BE, Capasso V, Mitchell MT, Kilroy SM, Lussier-Cushing M, Sumner L, Repper-Delisi J, Kelleher EP, Delisle LA, Cruz C, Stern TA

BACKGROUND: Falls and delirium in general-hospital inpatients are related to increases in morbidity, mortality, and healthcare costs. Patients fall despite safeguards and programs to reduce falling. OBJECTIVE: The authors sought to determine the prevalence of diagnosed and undiagnosed delirium in patients who fell during their hospital stay. METHOD: The authors performed a retrospective electronic chart review of 252 patients who fell during their hospital stay. Falls were categorized by their severity (i.e., minor, moderate, and major). Demographic information, patient outcomes, and diagnostic criteria for delirium (per DSM-IV) were collected on the day of admission, the day of the fall, and the 2 days preceding the patient’s fall. RESULTS: Falls in the general hospital were associated with delirium (both diagnosed and undiagnosed), advanced age, and specific surgical procedures. CONCLUSION: Improving the recognition of undiagnosed delirium may lead to sustainable and successful fall prevention programs. Detection of impairments in mental status can assist staff to create individualized patient care plans. Knowledge about which patients are at risk for injury from delirium and falls can lead to improvements in patient safety, functioning, and quality of life.

PMID: 19567760 [PubMed - indexed for MEDLINE]

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Impact of delirium on short-term mortality in elderly inpatients: a prospective cohort study.

Psychosomatics. 2009 May-Jun;50(3):234-8

Authors: González M, Martínez G, Calderón J, Villarroel L, Yuri F, Rojas C, Jeria A, Valdivia G, Marín PP, Carrasco M

BACKGROUND: Delirium is an important problem especially in older medical inpatients. OBJECTIVE: The authors asked whether delirium and its duration are associated with higher mortality in a 3-month follow-up period. METHOD: In this prospective cohort study, inpatients age 65 and older were assessed every 48 hours with the Confusion Assessment Method. RESULTS: Of 542 patients enrolled, 192 (35.4%) developed delirium. After 3 months, mortality in the delirium cohort was 25.9%, and in the nondelirium cohort was 5.8%. Delirium was independently associated with mortality, and increased by 11% for every 48 hours of delirium. CONCLUSION: Delirium and increased delirium durations are significantly associated with higher mortality.

PMID: 19567762 [PubMed - indexed for MEDLINE]

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Successful implementation of an alcohol-withdrawal pathway in a general hospital.

Psychosomatics. 2008 Jul-Aug;49(4):292-9

Authors: Repper-DeLisi J, Stern TA, Mitchell M, Lussier-Cushing M, Lakatos B, Fricchione GL, Quinlan J, Kane M, Berube R, Blais M, Capasso V, Pathan F, Karson A, Bierer M

BACKGROUND: Although alcohol use and abuse are common among general-hospital inpatients, many patients are inadequately assessed and treated for alcohol withdrawal. OBJECTIVE: The purpose of this study was to determine whether the implementation of a clinical pathway for the treatment of alcohol withdrawal in medical inpatients would result in improvements in clinical practice and patient outcomes. METHOD: Authors retrospectively reviewed 80 patient records (including 40 of those treated before the implementation of a pathway and 40 of those treated after pathway implementation). RESULTS: Assessment procedures and ordering patterns of physicians (medical house staff and staff physicians) shifted in a fashion consistent with the new treatment guidelines. Patient outcomes (e.g., length of stay and the incidence of delirium) improved for those patients who received benzodiazepines within the range of the pathway guidelines. CONCLUSIONS: Timely assessment and staff education can shift prescription patterns, increase patient monitoring, and reduce costs associated with alcohol withdrawal.

PMID: 18621934 [PubMed - indexed for MEDLINE]

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