Todd Kristine S, Barry Jean, Hoppough Susan, McConnell Eleanor
Duke University School of Nursing.
Mercy Health Saint Mary's.
Int J Orthop Trauma Nurs. 2015 Nov;19(4):214-21. doi: 10.1016/j.ijotn.2015.03.005. Epub 2015 Mar 28.
Delirium is a common and potentially devastating problem for older patients following hip fracture. Although early detection is recommended, description and evaluation of standardized approaches are scarce. The aims of this quality improvement project were to: (1) implement a clinical algorithm for improving delirium detection and management and (2) assess the impact of the clinical algorithm on length of stay, discharge disposition and patient satisfaction. The pilot study was implemented on an orthopedic unit to evaluate the effectiveness of a clinical protocol for delirium detection and management to improve outcomes. Outcomes of 33 elderly post-operative hip fracture patients were compared to historical controls from the same unit. Delirium was detected in 18% of patients. Length of stay was reduced by 22% (P < .001), discharge disposition showed a 13% improvement (P = .17) and patient satisfaction scores showed a 15% (P = .15) improvement post-intervention. Implementation of a clinical algorithm to promote early detection and treatment of delirium in post-operative hip fracture patients is feasible and associated with improved outcomes.
谵妄是老年髋部骨折患者常见且可能具有严重破坏性的问题。尽管建议早期检测，但关于标准化方法的描述和评估却很少。这个质量改进项目的目标是：（1）实施一种临床算法以改善谵妄的检测和管理；（2）评估该临床算法对住院时间、出院处置和患者满意度的影响。该试点研究在一个骨科病房开展，以评估一种谵妄检测和管理临床方案改善治疗效果的有效性。将33例老年髋部骨折术后患者的治疗结果与同一病房的历史对照患者进行比较。18%的患者被检测出谵妄。干预后住院时间缩短了22%（P < 0.001），出院处置改善了13%（P = 0.17），患者满意度得分提高了15%（P = 0.15）。实施临床算法以促进对髋部骨折术后患者谵妄的早期检测和治疗是可行的，且与改善治疗效果相关。
