(1251) Increasing the Detection of Delirium in the Intensive Care Unit at Saint Luke's Hospital

Introduction: Studies have shown that each day spent in delirium is associated with a 10% increase in death at six months post-hospitalization. It is also estimated that delirium accounts for 4-16 billion dollars in healthcare spending in the United States per year. Due to recent turnover in the number of nursing staff at Saint Luke’s Hospital, it was felt anecdotally through staff that there may not be adequate training on RASS/CAM-ICU assessments for delirium. Further investigation found that the delirium prevalence in the Saint Luke’s ICU ranged anywhere from 12-19% when we looked at baseline average of August 2022 (see Table 1), clearly indicating under detection. We know the average prevalence of delirium in ICU’s nationwide is around 50% and can even rise close to 75%. Between the period of December 7th, 2023 - May 1st, 2023, we hope to raise the delirium detection rate in Saint Luke’s Hospital MSTICU by 15%, thereby giving families more clarity as to why their loved ones are acting strangely and helping management teams understand more context around the patient, allowing for better healthcare.

Methods: After meeting with an interdisciplinary team of medical professionals, we decided the best intervention to implement was “delirium rounds” for nursing staff (see Chart 1 and Table 2). These entailed doing interactive teaching rounds with pairs of nurses at a time with a focus on RASS/CAM-ICU education.

Results: After rounding with all of the nurses on the dayshift, results are shown below (see Table 3). We at first saw an increase in detection; however, shortly after we stopped rounding there was a sharp decline. Anecdotally, we received great reviews from the nurses that they appreciated a refresh on RASS/CAM-ICU; there had been a lot of nursing turnover this past year and having someone support their learning was much appreciated. The only balancing measure that was noted was that these rounds were time intensive and took time away from the nurse educators’ other projects.

Conclusions: We found that implementing educational rounds was effective in increasing delirium detection. The major downside was with cessation of these rounds, the rate of detection dropped again.