Acute Crit Care.  2018 Feb;33(1):23-33. 10.4266/acc.2017.00584.

The Effects of a Delirium Notification Program on the Clinical Outcomes of the Intensive Care Unit: A Preliminary Pilot Study

• Park J
• Oh ST
• Park S
• Choi WJ
• Shin CS
• Na SH
• Kim JJ
• Oh J
• Park JY

• KMID: 2436304
• DOI: http://doi.org/10.4266/acc.2017.00584

Abstract

BACKGROUND
Delirium is common among intensive care unit (ICU) patients, so recent clinical guidelines recommended routine delirium monitoring in the ICU. But, its effect on the patient's clinical outcome is still controversial. In particular, the effect of systems that inform the primary physician of the results of monitoring is largely unknown.
METHODS
The delirium notification program using bedside signs and electronic chart notifications was applied to the pre-existing delirium monitoring protocol. Every patient was routinely evaluated for delirium, pain, and anxiety using validated tools. Clinical outcomes, including duration of delirium, ICU stay, and mortality were reviewed and compared for 3 months before and after the program implementation.
RESULTS
There was no significant difference between the two periods of delirium, ICU stay, and mortality. However, anxiety, an important prognostic factor in the ICU survivor's mental health, was significantly reduced and pain tended to decrease.
CONCLUSIONS
Increasing the physician's awareness of the patient's mental state by using a notification program could reduce the anxiety of ICU patients even though it may not reduce delirium. The results suggested that the method of delivering the results of monitoring was also an important factor in the success of the delirium monitoring program.

Keyword

anxiety; critical illness; delirium; intensive care units; pain; reminder systems

MeSH Terms

Anxiety
Critical Care*
Critical Illness
Delirium*
Humans
Intensive Care Units*
Mental Health
Methods
Mortality
Pilot Projects*
Reminder Systems

Figure

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  Figure 1. Delirium notification program. (A) Bedside sign: if the patient is confirmed as delirious, the intensive care unit (ICU) nursing staff attached this bedside sign under the patient identification table. When a primary care physician identifies the patient during daily rounding, he or she will see this sign. (B) Warning sign on the electronic medical record (EMR): to see the EMR of a particular patient, a physician must press the blue box. If delirium is present, the delirium warning box will be highlighted in red among a series of alert boxes located above the blue box. When the doctor moves the mouse cursor over the red box, a yellow box with the word “in delirium” will appear. The image is part of the EMR program screen currently in use. CAM: Confusion Assessment Method.

• 

  Figure 2. Flowchart of inclusion and subgrouping. (A) Before notification: from January to March 2014. (B) After notification: from January to March 2015. Anxiety was assessed using Hamilton Anxiety Rating Scale and pain was assessed using Numeric Rating Scale for Pain. ICU: intensive care unit.

• 

  Figure 3. Effects of the delirium notification system on distress. (A) Hamilton Anxiety Rating Scale (HAMA) scores for the before- and after-notification groups (12.30 ± 5.59 vs. 11.18 ± 5.29; F[1, 127.689] = 4.271; P = 0.040). (B) Numeric Rating Scale for Pain (NRS-Pain) scores for the before- and after-notification groups (2.67 ± 2.40 vs. 2.29 ± 0.80; F[1, 13.322] = 3.850; P = 0.051). Before-notification group: January–March 2014; After-notification group: January–March 2015. Error bars, *P < 0.05.

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