James T. Reston, PhD, MPH; Karen M. Schoelles, MD, SM
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Disclaimer: All statements expressed in this work are those of the authors and should not in any way be construed as official opinions or positions of ECRI Institute, the AHRQ, or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Allison Gross, MS, MLS, for performing literature searches and Katherine Donahue and Lydia Dharia for editing and formatting the manuscript.
Financial Support: From AHRQ, U.S. Department of Health and Human Services (contract HHSA-290-2007-10062I).
Potential Conflicts of Interest: Dr. Reston: Grant (money to institution): AHRQ, U.S. Department of Health and Human Services. Dr. Schoelles: Support for travel to meetings for the study or other purposes (money to institution): Rand Corporation. Other (money to institution):Rand Corporation. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2566.
Requests for Single Reprints: James T. Reston, PhD, MPH, ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298; e-mail, email@example.com.
Current Author Addresses: Drs. Reston and Schoelles: ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298.
Author Contributions: Conception and design: J.T. Reston, K.M. Schoelles.
Analysis and interpretation of the data: J.T. Reston, K.M. Schoelles.
Drafting of the article: J.T. Reston, K.M. Schoelles.
Critical revision of the article for important intellectual content: J.T. Reston, K.M. Schoelles.
Final approval of the article: K.M. Schoelles.
Obtaining of funding: K.M. Schoelles.
Administrative, technical, or logistic support: K.M. Schoelles.
Collection and assembly of data: J.T. Reston.
Delirium, an acute decline in attention and cognition, occurs among hospitalized patients at rates estimated to range from 14% to 56% and increases the risk for morbidity and mortality. The purpose of this systematic review was to evaluate the effectiveness and safety of in-facility multicomponent delirium prevention programs. A search of 6 databases (including MEDLINE, EMBASE, and CINAHL) was conducted through September 2012. Randomized, controlled trials; controlled clinical trials; interrupted time series; and controlled before–after studies with a prospective postintervention portion were eligible for inclusion. The evidence from 19 studies that met the inclusion criteria suggests that most multicomponent interventions are effective in preventing onset of delirium in at-risk patients in a hospital setting. Evidence was insufficient to determine the benefit of such programs in other care settings. Future comparative effectiveness studies with standardized protocols are needed to identify which components in multicomponent interventions are most effective for delirium prevention.
Table. The Most Common Components of Successful Delirium Prevention Programs
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James T. Reston, Karen M. Schoelles. In-Facility Delirium Prevention Programs as a Patient Safety Strategy: A Systematic Review. Ann Intern Med. 2013;158:375–380. doi: 10.7326/0003-4819-158-5-201303051-00003
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Published: Ann Intern Med. 2013;158(5_Part_2):375-380.
Delirium, Healthcare Delivery and Policy, Hospital Medicine, Neurology, Prevention/Screening.
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