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Delirium Toolbox

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What is Delirium?
         
Delirium is a common, morbid, and costly condition. From the healthcare system standpoint, delirium leads to more inpatient and long term care costs. From the patient standpoint, patients who develop delirium in the hospital, frequently go to rehabilitation facilities because of functional decline, both physical and cognitive. In rehabilitation, a substantial portion of those who are delirious will not return to their functional baseline and will go to long-term care. Compared to age, gender and comorbidity controls, a patient who develops delirium will accrue an additional $16000 - $64000 over the subsequent year. Most of this represents cost of institutionalization. Importantly, 30% - 40% of delirium is preventable. As a result, preventing delirium during the inpatient hospitalization can prevent the cascade of events leading to institutionalization.
        
What is The Delirium Toolbox Project?
       
The Delirium Toolbox is a quality improvement project that has been screening patients for delirium risk upon admission to certain VA Boston Healthcare System facilities. To improve recognition and reduce incidence of delirium, the delirium toolbox team has screened over 3,000 patients utilizing the Clock in the Box assessment tool, intervened with items from the toolbox to modify risk, and alerted healthcare providers to patients’ probability of onset. Additionally, the program has been developing system wide prevention strategies for all patients and is evaluating the impact of length of stay, re-admission, and nursing home placement. Learn more about the Clock in The Box here.
Inside the Delirium Toolboxes are items to improve sensory input, cognition, and sleep (hearing amplifiers, readers, puzzles, playing cards, ear plugs, etc.). With the aid of multidisciplinary teams encouraging the utilization of these everyday items, we can significantly reduce delirium onset in the hospital setting.
      
Delirium Toolbox Objective
        
The goal of this program is to prevent delirium in patients admitted to the hospital using three steps:
       
  • Screening for delirium risk 
  • Using the Delirium Toolbox to modify delirium risk 
  • Develop a standard order set for delirium