ISQUA17-1772IMPROVING CARE FOR OLDER ACUTE INPATIENTS: AN ECONOMIC EVALUATION OF THE DELIRIUM CLINICAL CARE STANDARD

Abstract

Objectives: Delirium, an acute confusional state, is a medical emergency, can affect up to 30% of acute admissions, and is associated with increased morbidity and mortality. This study will evaluate whether implementing the Delirium Clinical Care Standard (Standard) is cost-effective in improving the diagnosis and management of delirium in acute care in Australia. Method(s): This study uses a mixed methods design to evaluate Standard implementation in an acute care public hospital. For the quantitative arm, the medical records (n = 1250) of patients over 65 years and admitted to four study wards (medical, surgical, and intensive care) during month 1 and month 4 of the study period will be reviewed by trained nurse researchers. The Standard will be implemented in month 2 by an acute care public hospital in accordance with their planned quality improvement strategy, using a Logic Model approach to build an implementation plan. For the qualitative arm, nursing staff (n = 10) on study wards will be interviewed in month 2 and 4 to investigate implementation issues. Patients with resolved delirium (n = 10), and family members and carers (n = 10) will be interviewed in Month 4 to investigate the patient experience in delirium and inform the assessment of the Standard. An economic evaluation will determine the costs and benefits of the Standard, using activity based costing methods and outcome data collected from the medical record reviews. Result(s): The main outcome will be the incidence of delirium before and after implementing the Standard. Other outcomes of interest include the timing and use of cognitive screening tests, identification of high risk patients, length of stay, discharge disposition, psychotropic drug use, age appropriate anaesthetic use, and compliance with the Standard in terms of providing personalized care plans for patients at high risk of developing delirium. These outcomes, and the results of the economic evaluation, will be presented to the hospital staff, health departments, and health safety and quality bodies as part of the quality improvement and implementation best practice process. Conclusion(s): Delirium is a largely preventable medical emergency requiring prompt diagnosis and treatment. The Standard comprises international evidence based interventions for identifying, preventing, and treating delirium. This study will provide data for scaling up implementation of the Standard on a national scale, and for collaboration in international efforts to reduce this important hospital acquired condition. The study also provides a blue-print for designing, implementing, and improving, other clinical care standards.