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In-hospital delirium predictive of readmission, discharge to postacute facilities, ER visits

Hospital Safety Insider, April 25, 2019

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By Christopher Cheney, HealthLeaders Media

In-hospital delirium is a predictor of readmission, emergency department visits, and discharge to a location other than home, recent research shows.

The development of delirium in the hospital setting impacts about 12.5% of general medical admissions and as many as 81% of intensive care unit patients. Earlier research has shown delirium among hospitalized patients is predictive of prolonged hospital length stay, lengthened mechanical ventilation, and mortality.

The recent research in the Journal of Hospital Medicine featured data collected from more than 700 delirious patients and nearly 8,000 non-delirious patients. The researchers found delirious patients had increased odds for 30-day readmissions, ED visits, and discharge to postacute care facilities.

“These results suggest that patients with delirium are particularly vulnerable in the posthospitalization period and are a key group to focusing on reducing readmission rates and post-discharge healthcare utilization,” the researchers wrote.

Link between in-hospital delirium and readmissions

The Journal of Hospital Medicine research builds on earlier studies about in-hospital delirium, the lead author of the research told HealthLeaders.

“Prior studies have shown that delirium is associated with functional decline at discharge, so these patients may be particularly vulnerable in the days and weeks following hospital discharge. Our work helps to confirm this as we show that patients who become delirious in the hospital are far more likely to be readmitted within 30 days of discharge, compared with patients who do not develop delirium,” said Sara LaHue, MD, a 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 at delirious patients to reduce readmissions, she said. “Hospital-based interventions that reduce the development of delirium may then reduce the complications of delirium, such as readmission.”

Reducing delirium-associated postacute care service utilization

To avoid hospital readmissions linked to delirium, clinicians should focus on preventing patients from becoming delirious in the hospital, LaHue said.

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

One team member who is often overlooked is the caregiver at home, she said.

“Educating caregivers about delirium risk factors can be very helpful—he or she can bring glasses or hearing aids from home, engage the patient in meaningful conversation to help with orientation, and encourage regulation of sleep-wake cycles. If a patient does become delirious, the caregiver can continue to help with these interventions.”

Caregivers at home are an essential component of postacute care, LaHue said.

“We know that delirium is associated with functional decline at discharge, so coordinating safe discharge plans with the caregiver, especially to identify need for resources—physical therapy, occupational therapy, home health, and nursing—can potentially help reduce post-discharge complications.”

Follow-up care is another crucial factor, she said. “Ensuring expedited follow-up with a primary care provider, who can assess for any additional needs, is also important.”

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