Although often undiagnosed and untreated, delirium is a common, serious, and potentially preventable condition that is generally understood to be sudden disorientation and mental confusion that develops in hospitalized patients. Delirium can result in shortened attention span and fluctuating levels of consciousness. Symptoms ranging from quiet lack of connection to the external environment to incoherent speech, severe anxiety, and even hallucinations and high aggressive behavior can disappear shortly after discharge or persist long after the patient has left the hospital. Each year, delirium results in increased morbidity and mortality for at-risk patients and complicates and lengthens hospital stays, resulting in increased need for post-hospital institutionalization, rehabilitation, and home care.
Symptoms can be prevented or ameliorated by accurately identifying those at risk and engaging them through a variety of protocols that address patient orientation/engagement, family and medical staff education, early mobilization, enhanced nutrition/feeding, proper sleep cycles, and avoidance of certain specific medications.
To help combat hospital-acquired delirium, HFNJ issued a Request for Proposals to local hospitals in the spring of 2011, with the goal of improving patient care and reducing hospital costs. Four hospitals were initially awarded grants, with three additional hospitals included the following year. The project is ongoing, with positive results that are changing the culture of care. Most grantees have now taken over financial responsibility for the program or will do so shortly.
- Foundation of Morristown Medical Center – to expand its Hospital Acquired Delirium (“HAD”) Program by instituting an early mobilization /ambulation program for at-risk patients.
- Foundation of UMDNJ – to expand University Hospital’s interdisciplinary approach to combating HAD among patients 50+ years of age in its ICU and Trauma Units.
- Newark Beth Israel Medical Center Foundation – to initiate a program to prevent, identify, and treat HAD among patients 65+ years of age with the hiring of an Activity Therapist and the creation of an Activity Room and other physical changes to enhance engagement and safety for those at risk.
- Overlook Hospital Foundation – to enhance its existing HAD program by hiring four part-time Elderlife Specialists to provide for the needs of at-risk patients and their families, educate families and staff, and collect data through daily rounds and by talking to nurses. The project will be hospital-wide in 2015.
- Clara Maass Medical Center Foundation – to initiate a HAD program for patients 70+ years on one pilot medical-surgical unit. The program has now expanded to additional units of the hospital.
- Foundation for Trinitas Regional Medical Center – to initiate a HAD program on one medical-surgical unit with the hire of a bilingual Elder Life Specialist and Elder Life Assistant. In Year 2 the program was rolled out to five additional units and touched approximately 3,000 patients.
- Saint Barnabas Medical Center Foundation – to initiate a HAD program for patients 65+ years of age and institute protocols to engage/orient patients at risk, monitor patient medications, improve sleep cycles, reduce the use of sitters and restraints, and lower the incidence of falls.