BACKGROUND: Delirium is associated with poor clinical outcomes that could be improved with targeted interventions.

OBJECTIVE: To determine whether a multicomponent delirium care pathway implemented across seven specialty nonintensive care units is associated with reduced hospital length of stay (LOS). Secondary objectives were reductions in total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use.

METHODS: This retrospective cohort study included 22,708 hospitalized patients (11,018 preintervention) aged ≥50 years encompassing seven nonintensive care units: neurosciences, medicine, cardiology, general and specialty surgery, hematology-oncology, and transplant. The multicomponent delirium care pathway included a nurse-administered delirium risk assessment at admission, nurse-administered delirium screening scale every shift, and a multicomponent delirium intervention. The primary study outcome was LOS for all units combined and the medicine unit separately. Secondary outcomes included total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use.

RESULTS: Adjusted mean LOS for all units combined decreased by 2% post intervention (proportional change, 0.98; 95% CI, 0.96-0.99; P = .0087). Medicine unit adjusted LOS decreased by 9% (proportional change, 0.91; 95% CI, 0.83-0.99; P = .028). For all units combined, adjusted odds of 30-day readmission decreased by 14% (odds ratio [OR], 0.86; 95% CI, 0.80-0.93; P = .0002). Medicine unit adjusted cost decreased by 7% (proportional change, 0.93; 95% CI, 0.89-0.96; P = .0002).

CONCLUSION: This multicomponent hospital-wide delirium care pathway intervention is associated with reduced hospital LOS, especially for patients on the medicine unit. Odds of 30-day readmission decreased throughout the entire cohort.

背景：谵妄与较差的临床结果相关，可以通过有针对性的干预来改善。

O目标：确定跨七个专科非重症监护病房实施的多组分谵妄护理路径是否与缩短住院时间 (LOS) 相关。次要目标是降低总直接成本、30 天再入院的几率以及安全人员和约束装置的使用率。

方法：这项回顾性队列研究包括 22,708 名住院患者（11,018 名干预前），年龄≥50 岁，包括七个非重症监护病房：神经科学、医学、心脏病学、普通和专科外科、血液肿瘤学和移植。多组分谵妄护理途径包括入院时由护士管理的谵妄风险评估、每班由护士管理的谵妄筛查量表和多组分谵妄干预。主要研究结果是所有单元合并和医学单元分开的 LOS。次要结果包括总直接成本、30 天再入院的几率以及安全人员和约束装置的使用率。

结果：干预后所有单位的调整后平均 LOS 降低了 2%（比例变化，0.98；95% CI，0.96-0.99；P = .0087）。医学单位调整后的 LOS 降低了 9%（比例变化，0.91；95% CI，0.83-0.99；P = .028）。对于所有单位，调整后的 30 天再入院几率降低了 14%（优势比 [OR]，0.86；95% CI，0.80-0.93；P = .0002）。医药单位调整成本降低了 7%（比例变化，0.93；95% CI，0.89-0.96；P = .0002）。

结论：这种多成分的全医院谵妄护理途径干预与降低医院 LOS 相关，尤其是对于医疗单位的患者。在整个队列中，30 天再入院的几率降低。