Theresa Savino, Franz H Vergara, Mary Dioise Ramos, Deborah Warzecha
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引用次数: 0
Abstract
Background: Delirium is a serious complication in patients in the critical care unit (CCU) that may lead to prolonged hospitalization if left undetected. The CCU at our hospital does not have a framework for determining delirium that could affect patient outcomes and discharge planning.
Primary practice setting: CCU in a community hospital.
Method: A posttest-only design was used for this study. We established a framework for the early assessment of delirium, educated and trained nurses to detect delirium, collaborated with the informatics department, intensivist, nursing, respiratory therapy and worked with case management to deploy the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We used a one-tailed independent t test to determine the impact of CAM-ICU on length of stay (LOS). Cross-tabulation and chi-square tests were used to examine the impact of CAM-ICU tool on home care utilization between the intervention and comparison groups.
Results: There was a 3.12% reduction in LOS after implementing the CAM-ICU tool. Also, a reduction in home care service utilization demonstrated statistical significance ( p = .001) between the intervention group (62.5%; n = 177) and the comparison group (37.5%; n = 106).
Implications for case management practice: Case managers are essential in improving care transitions. Case managers need to become competent in understanding the implications of the CAM-ICU tool because of their relevant role in the multidisciplinary rounds as advocates to improve care transitions across the continuum of care. Case managers need to have an understanding on how to escalate when changes in the Richmond Agitation-Sedation Scale scores occur during the multidisciplinary rounds because it can affect care coordination throughout the hospital.
Conclusions: Implementing the CAM-ICU decreased LOS, and reduced health care utilization. The early identification of patients with delirium can affect the outcomes of critically ill patients and entails multidisciplinary collaboration.
期刊介绍：
Professional Case Management: The Leader in Evidence-Based Practice is a peer-reviewed, contemporary journal that crosses all case management settings. The Journal features best practices and industry benchmarks for the professional case manager and also features hands-on information for case managers new to the specialty. Articles focus on the coordination of services, management of payer issues, population- and disease-specific aspects of patient care, efficient use of resources, improving the quality of care/patient safety, data and outcomes analysis, and patient advocacy. The Journal provides practical, hands-on information for day-to-day activities, as well as cutting-edge research.
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