The effect of inpatient addiction screening and intervention on readmissions.

AIM: The number of individuals in the United States (US) needing treatment for substance use disorder (SUD) but not receiving treatment at a specialty facility was reported to be almost 18 million in 2019. This study measured the difference in subsequent hospital visits between groups, one receiving screening, brief intervention, and referral to treatment (SBIRT) and one receiving usual care. BACKGROUND: There are studies that discuss SBIRT in terms of process evaluation, staff training, reduced readmission rates, and self-reported reductions in substance use. However, the interrelationship between components of SBIRT implementation, such as feasibility, cost, and sustainability need additional investigation. This study compared readmissions between groups receiving SBIRT counseling (n = 101) and those receiving usual care (n = 99). RESULTS: The overall total number of subsequent visits for SUD for the group receiving SBIRT (53) was significantly lower than for the group receiving usual care (128). The overall total number of non-SUD subsequent visits was not significantly different between groups. The study also identified differences between sexes that require further investigation. CONCLUSIONS: The findings of this study demonstrate a measure of difference based on SBIRT intervention. The SBIRT program can be incorporated into daily practice in the acute care setting through nursing education and utilization of the electronic health platform.

Quality improvement and cost savings with multicomponent delirium interventions: replication of the Hospital Elder Life Program in a community hospital.

OBJECTIVE: Delirium is a common problem associated with increased morbidity, mortality, and healthcare costs in the hospitalized elderly, yet there is little research outside of academic medical centers exploring methods to prevent its onset. The authors adapted the Hospital Elder Life Program (HELP) for use in a community hospital and assessed its impact on delirium rate, length of stay (LOS) and healthcare costs in elderly patients. METHODS: Delirium episodes and duration, total patient-days with delirium and LOS were assessed in 595 patients 70 years of age or older admitted to a general medical floor at a community hospital. Pre-intervention outcomes were assessed on the medical floor for 4 months. Interventions adapted from HELP occurred over 9 months and included daily visits, therapeutic activities, and assistance with feeding, hydration, sleep, and vision/hearing impairment. Delirium was assessed on a daily basis with the Confusion Assessment Method (CAM). RESULTS: The rate of episodes of delirium decreased from 20% in the pre-intervention group to 12% in the intervention group, a relative 40% reduction (P = 0.019). Total patients days with delirium decreased from 8% in the usual care group to 6% in the intervention group (P = 0.005). LOS among all patients enrolled in the intervention group decreased by 2 days (P < 0.001). Interventions resulted in $841,000 cost savings over 9 months. CONCLUSIONS: HELP can be successfully adapted for implementation in a community hospital setting to decrease delirium episodes, total patient-days with delirium and LOS, and generate substantial cost savings.

Impact of delirium on decision-making capacity after hematopoietic stem-cell transplantation.

BACKGROUND: Delirium is a common complication of myeloablative hematopoietic stem-cell transplantation (HSCT), yet no studies have explored the later effects of an episode of delirium in this setting on patients' decision-making capacity after the acute symptoms of delirium have resolved. OBJECTIVE: The authors assessed the impact of delirium during the acute phase of myeloablative HSCT on later decision-making capacity. METHOD: Decision-making capacity was assessed with the MacArthur Competence Assessment Tool in 19 patients before they received their first HSCT and at 30 and 80 days post-transplantation. Delirium was assessed 3 times per week with the Delirium Rating Scale and the Memorial Delirium Assessment Scale from 7 days pre-transplantation through 30 days post-transplantation. RESULTS: Although there was little variance in the pre-treatment scores, with most patients showing very high or perfect scores on decision-making abilities, a multivariate regression model showed that delirium was predictive of a lower reasoning score at Day 30 post-transplantation. CONCLUSION: Patients who experienced a delirium episode during the acute phase of HSCT were not likely to develop clinically meaningful impairments in decision-making capacity post-transplantation, although they evidenced minor impairment in their reasoning ability.

Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery.

BACKGROUND: Previous studies have reported an 11% to 75% incidence of postoperative cognitive decline among cardiac surgery patients. The INVOS Cerebral Oximeter (Somanetics Corp, Troy, MI) is a Food and Drug Administration approved device that measures regional cerebral oxygen (rSo(2)) saturation. The purpose of this study is to examine whether decreased rSo(2) predicts cognitive decline and prolonged hospital stay after coronary artery bypass grafting (CABG). METHODS: The rSo(2) was monitored intraoperatively in a cohort of primary CABG patients. Patients were prospectively randomized to a blinded control group or an unblinded intervention group. Cognitive function was assessed preoperatively, postoperatively, and at 3 months using a battery of standardized neurocognitive tests. Cognitive decline was defined as a decrease of one standard deviation or more in performance on at least one neurocognitive measure. The rSo(2) desaturation score was calculated by multiplying rSo(2) below 50% by time (seconds). Multivariate logistic regression models were used to assess cognitive decline and hospital stay. The change in cognitive performance was also assessed using a multivariate linear regression model. RESULTS: Patients with rSo(2) desaturation score greater than 3,000%-second had a significantly higher risk of early postoperative cognitive decline [p = 0.024]. Patients with rSo(2) desaturation score greater than 3,000%-second also had a near threefold increased risk of prolonged hospital stay (>6 days) [p = 0.007]. CONCLUSIONS: Intraoperative cerebral oxygen desaturation is significantly associated with an increased risk of cognitive decline and prolonged hospital stay after CABG.