Objective: To investigate if a reorganization of nursing and medical care improves the outcome of older delirious patients admitted to general internal medicine.
Design: A prospective randomized intervention study.
Materials and Methods: 400 consecutive patients, aged 70 years and older, admitted to the Department of General Internal Medicine at Sundsvall Hospital in Sundsvall, Sweden were included. 200 patients were admitted to intervention ward and 200 patients to the control ward.
The intervention program consisted of 4 parts:
1. 2 days of staff education on geriatric medicine with focus on dementia, delirium, and the examinations necessary to diagnose and treat these conditions.
2. Reorganization from a task allocation care system to a patient allocation system with individualized care.
3. Education on caregiver-patient interaction with focus on patients with dementia and delirium.
4. Continuous guidance.
The patients were assessed using the Organic Brain Syndrome Scale (OBS Scale) and the Mini Mental State Examination (MMSE)at days 1, 3, and 7 after admission. Medical and social data were collected from the patients, their caregivers, and from medical records. Delirium was diagnosed according to DSM-IV criteria.
Results: There was no difference in the incidence of delirium on admission between the intervention ward and control ward (n=63 (31.5%) vs. 62 (31.0%), p=0.914), but the incidence of delirium at day 7 after admission was significantly lower at the intervention ward than at the control ward (n=19 (9.5%) vs. 39 (19.5%), p=0.005). The median length of stay was significantly lower at the intervention ward compared to the control ward (9.4±8.2 vs. 13.2±12.3 days, P<0.001). The median length of stay was also significantly lower among the delirious patients in the intervention ward compared to the delirious patients at the control ward (10.8±8.3 vs. 20.0±17.3 days. P<0.001). Five patients in the intervention ward and eleven in the control ward died during hospitalization (p=0.126).
Conclusion: This study shows that a multi-disciplinary intervention program including education, guidance, and changed caring organization reduces the duration of delirium and shortens the length of hospital stay for older patients admitted to general internal medicine.
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