Integrating mental health professionals into the care team to better recognize and manage delirium in hospitalized oncology patients.

Abstract

83 Background: Delirium is a common neuropsychiatric condition associated with increased morbidity and mortality, length of hospitalization, and distress. The prevalence of delirium in cancer ranges from 10% to 30% in hospitalized patients and up to 85% in terminally ill cancer patients. Rates of delirium on Cleveland Clinic’s inpatient oncology units were lower than expected. Our goal was to integrate mental health professionals into the care team to assist with better recognition and management of delirium. Methods: Education was developed for a range of caregivers, including physicians, nurses, and advanced practice providers. It was facilitated by a psychiatrist, psychologist, and clinical social workers, and included proper identification of both hyper- and hypoactive delirium through use of the Brief Confusion Assessment Method (bCAM) and use of a delirium order set to treat and manage patients identified as positive for delirium. An important component of this education included a proper assessment and comparison of patients’ current mental status compared to their true baseline prior to hospitalization. Additional integration directly into the care team included participation of the psychiatrist, psychologist, and clinical social workers into each team’s multidisciplinary rounds to facilitate discussions around delirium and its appropriate management, and separate targeted rounding which included one-to-one education with front-line caregivers. Results: During the first year of integration, substantial improvements were noted. The percentage of patients identified as positive for delirium through bCAM screening increased from 3.4% to 15.8% after 12 months, and utilization of the delirium order set increased from 11.1% to 58.3%. Additionally, the average nursing unit length of stay (LOS) for delirium-positive patients decreased by more than 2 days compared to baseline. Conclusions: Integration of mental health providers into the care team to assist with recognizing and managing patients with delirium and to provide direct education to front-line caregivers has helped to rapidly improve delirium identification and management for oncology inpatients.