Quality of care in hospitalized cancer patients before and after implementation of a systematic prevention program for delirium: the DELTA exploratory trial
We evaluated whether the DELirium Team Approach (DELTA) program—a systematic management program aimed at screening high-risk groups and preventing delirium—would improve quality of care in patients hospitalized with cancer.
A retrospective before–after study was conducted during a pre-intervention period (between October 2012 and March 2013) and a post-intervention period (between October 2013 and March 2014) at a Japanese hospital providing specialized treatments for cancer. A total of 4180 inpatients were evaluated before the implementation of the DELTA program and 3797 inpatients were evaluated after implementation.
After program implementation, the incidence of delirium decreased from 7.1 to 4.3% (odds ratio [OR], 0.52; 95% CI, 0.42–0.64). The incidence of adverse events, including falls or self-extubation, also decreased, from 3.5 to 2.6% (OR, 0.71; 95% CI, 0.54–0.92). There was a significant decrease in the prescription of benzodiazepines (OR, 0.79; 95% CI, 0.71–0.87), increase in the level of independence in activities of daily living at discharge (OR, 1.94; 95% CI, 1.11–3.38), and decrease in the length of stay (risk ratio 0.90; 95% CI, 0.90–0.90).
The systematic management program for delirium decreased the incidence of delirium and improved several clinical outcomes. These data suggest that this simple cost-effective program is feasible and implementable as routine care in busy wards.
KeywordsCancer Cognitive impairment Delirium Education program Prevention
We are grateful to the staff who assisted in the program management, including Ms. Junko Ueda, Ms. Tomoko Nishimura, Dr. Hiroyuki Nobata, Dr. Yoshio Iwata, Ms. Yasuko Uchimura, and Ms. Kana Toyonaga, and to the staff in the Department of Nursing at the National Cancer Center Hospital East.
This work was supported by the National Cancer Center Research and Development Fund and by Japan Agency for Medical Research and Development Grants for Practical Research for Innovative Cancer Control, Grant Number 16ck0106216h0001.
Compliance with ethical standards
Research ethics and patient consent
This study was conducted in accordance with the amended Declaration of Helsinki and was approved by the Ethical Committee of the National Cancer Center, Japan (2014-028, approval no.: 2014-028). The full protocol is available from the corresponding author.
Conflict of interest
The authors declare that they have no conflict of interest.
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