Title

Implementation of Delirium Screening and Measures to Decrease Delirium Incidence in a Pediatric ICU

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Presentation

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Publication Date

4-16-2020

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Presentation: 49:07

Abstract

Introduction: Pediatric delirium is a preventable and avoidable cause of ICU morbidity and mortality. It is estimated to affect up to 56% of children in the PICU. Delirium prolongs ICU length of stay by 2.39 days and increases the cost per admission by $14,000. In spite of this recognition, the pediatric ICU at Children’s Hospital of Illinois had no reliable system of measuring and preventing delirium in children.

Methods: A rapid cycle quality improvement project was implemented to improve the delirium screening from baseline 0% to more than 80% within six months (07/19 to 12/19). The project relied on failure mode assessment, statistical process control for delirium assessment, intensive monitoring and utilization of principles of change management. Simultaneously efforts were also undertaken to decrease the rate of delirium. Outcome assessment and financial impact were also measured.

Results: A total of 2891 delirium screens were audited on 2227 patients with an average compliance rate of 91%. X bar and R chart analyses showed stable screening and documentation processes. Staff knowledge assessment scores increased from 6.58/10 (n=40) in the pre-implementation phase to 8.13/10 (n= 89). Family satisfaction surveys also showed improved family satisfaction with delirium prevention and treatment efforts. Significant improvement was noticed in the post-test scores (8.6/10 vs 5.5/10) after educational interventions. Rate of positive delirium screens decreased from 23.4% in July to 13.6% in December 2019. Significant improvement in ICU length of stay (1.49 vs 1.84 days), hospital length of stay (4.07 vs 5.08) and ventilator days (1.7 vs 3.68) was observed. This project lead to a cost savings of $ 1.5 million to the hospital.

Conclusions: A quality improvement project with emphasis on change management, empowerment of the staff in the process, and rigorous statistical process control with screening compliance can result in rapid improvement with significant outcome differences in a relatively short period of time.

Language

English

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