Preventing Delirium Takes a Village: Systematic Review and Meta‐analysis of Delirium Preventive Models of Care

• Published in: Journal of hospital medicine Vol. 14; no. 9; pp. 558 - 564
• Main Authors: Khan, Ariba, PhD, Olga Boukrina, Oh‐Park, Mooyeon, PhD, Nina A Flanagan, PhD, Maharaj Singh, Oldham, Mark
• Format: Journal Article
• Language: English
• Published: United States Frontline Medical Communications 01.09.2019
• Subjects: Delirium; Meta-analysis; Systematic review
• ISSN: 1553-5592; 1553-5606; 1553-5606
• DOI: 10.12788/jhm.3212

BACKGROUND Each hospital day of delirium incurs greater healthcare costs, higher levels of care, greater staff burden, and higher complication rates. Accordingly, administrators are incentivized to identify models of care that reduce delirium rates and associated costs. PURPOSE We present a systematic review and meta‐analysis of delirium prevention models of care. DATA SOURCES Ovid MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, EMBASE, and PsycINFO. STUDY SELECTION Eligible models of care were defined as provider‐oriented interventions involving revision of professional roles, multidisciplinary teams, and service integration. Included studies implemented multidomain, multicomponent interventions, used a validated delirium instrument, and enrolled a control group to evaluate efficacy or effectiveness. DATA EXTRACTION We extracted data on study design; Population, model of care, outcomes, and results. DATA SYNTHESIS A total of 15 studies were included. All but two studies reported reduction in delirium or its duration, and 11 studies reported statistically significant improvements. Using random effects models, the pooled odds ratios of delirium incidence were 0.56 (95% CI: 0.37‐0.85) from three randomized controlled trials, 0.63 (95% CI 0.37‐1.07) from four pre–post intervention studies, and 0.79 (95% CI: 0.46‐1.37) from three additional nonrandomized studies. CONCLUSIONS Several models of care can prevent delirium. In general, higher quality studies were more likely to demonstrate statistical significance of an effect. The diverse models of care included here explored interventions adapted to specific care settings, especially by addressing setting‐specific delirium risk factors. These care models illustrate a range of promising strategies that deserve growing recognition, refinement, and implementation.