The impact of rounds with a psychiatry team in the intensive care unit: A prospective observational pilot study evaluating the effects on delirium incidence and outcomes.

Adult Humans Delirium / epidemiology Prospective Studies Pilot Projects Incidence Aftercare Patient Discharge Intensive Care Units Length of Stay
Critical care Delirium prevention Multidisciplinary care Postoperative delirium

Journal

Journal of psychiatric research
ISSN: 1879-1379
Titre abrégé: J Psychiatr Res
Pays: England
ID NLM: 0376331

Informations de publication

Date de publication:
04 2023
Historique:
received: 30 04 2022
revised: 01 02 2023
accepted: 06 02 2023
pubmed: 13 2 2023
medline: 15 3 2023
entrez: 12 2 2023
Statut: ppublish

Résumé

Delirium in the intensive care unit (ICU) is a common but serious condition that has been associated with in-hospital mortality and post-discharge psychological dysfunction. The aim of this before and after study is to determine the effect of a multidisciplinary care model entailing daily ICU rounds with a psychiatrist on the incidence of delirium and clinical outcomes. To assess the impact of a proactive psychiatry consultation model in the surgical ICU on the incidence and duration of delirium. This was a prospective, single institution, observational controlled cohort pilot study of adult patients admitted to a surgical ICU. A control group that received standard of care (SOC) with daily delirium prevention care bundles in the pre-intervention period was compared to an intervention group, which had a psychiatrist participate in daily ICU rounds (post-intervention period). The primary outcome was delirium incidence. The secondary outcomes were: delirium duration, ventilator days, hospital and ICU length of stay, and in-hospital mortality. A total of 104 patients were enrolled and equally split between SOC and intervention groups; 95 contributed to analysis. The overall incidence of ICU delirium was 19%. SOC and intervention groups had similar rates of delirium (21% vs 18%, p = 0.72). None of the secondary outcomes statistically significantly differed between the two groups. Delirium in ICU patients is a potentially preventable condition with serious sequelae. There was no difference in delirium incidence or duration between patients receiving SOC or patients who had multidisciplinary rounds with a psychiatrist.

Sections du résumé

BACKGROUND
Delirium in the intensive care unit (ICU) is a common but serious condition that has been associated with in-hospital mortality and post-discharge psychological dysfunction. The aim of this before and after study is to determine the effect of a multidisciplinary care model entailing daily ICU rounds with a psychiatrist on the incidence of delirium and clinical outcomes.
OBJECTIVE
To assess the impact of a proactive psychiatry consultation model in the surgical ICU on the incidence and duration of delirium.
METHODS
This was a prospective, single institution, observational controlled cohort pilot study of adult patients admitted to a surgical ICU. A control group that received standard of care (SOC) with daily delirium prevention care bundles in the pre-intervention period was compared to an intervention group, which had a psychiatrist participate in daily ICU rounds (post-intervention period). The primary outcome was delirium incidence. The secondary outcomes were: delirium duration, ventilator days, hospital and ICU length of stay, and in-hospital mortality.
RESULTS
A total of 104 patients were enrolled and equally split between SOC and intervention groups; 95 contributed to analysis. The overall incidence of ICU delirium was 19%. SOC and intervention groups had similar rates of delirium (21% vs 18%, p = 0.72). None of the secondary outcomes statistically significantly differed between the two groups.
CONCLUSION
Delirium in ICU patients is a potentially preventable condition with serious sequelae. There was no difference in delirium incidence or duration between patients receiving SOC or patients who had multidisciplinary rounds with a psychiatrist.

Identifiants

DOI: 10.1016/j.jpsychires.2023.02.011 PMID: 36774832
pubmed: 36774832
pii: S0022-3956(23)00070-5
doi: 10.1016/j.jpsychires.2023.02.011
pii:
doi:

Types de publication

Observational Study Journal Article Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

64-70

Subventions

Organisme : NCATS NIH HHS
ID : UL1 TR001855
Pays : United States

Informations de copyright

Copyright © 2023 Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare that they have no conflicts of interest.

Auteurs

Katherine J Choi (KJ)

Division of Plastic and Reconstructive Surgery, University of California, Los Angeles (UCLA), 200 UCLA Medical Plaza, Suite 460, Los Angeles, CA, 90095, USA; Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Matthew Tan (M)

Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Kelly Jones (K)

Department of Psychiatry, Hoag Hospital, 1 Hoag Dr, Newport Beach, CA, 92663, USA; . Department of Psychiatry, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

David Sheski (D)

. Department of Psychiatry, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Stephanie Cho (S)

. Department of Psychiatry, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Thomas Garrick (T)

. Department of Psychiatry, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Anita Yau (A)

Biostatistics, Epidemiology, and Research Design, Southern California Clinical and Translational Science Institute, University of Southern California, 1845 N. Soto Street, Los Angeles, CA, 90033, USA.

Donald Solio (D)

Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Kimberly Sinclair (K)

Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Elvin Cervantes (E)

Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Rae Ann Castillo (RA)

Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Damon Clark (D)

. Department of Surgery, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Subarna Biswas (S)

. Department of Surgery, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Claudia Alvarez (C)

. Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 City Blvd. West, Suite 1600, Orange, CA, 92868-3298, USA.

Itamar Grunstein (I)

Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

J Perren Cobb (JP)

. Department of Surgery, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.

Catherine M Kuza (CM)

Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA. Electronic address: catherine.kuza@med.usc.edu.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › The impact of rounds with a psychiatry team in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The impact of rounds with a psychiatry team in...
questionsmedicales.fr › Troubles mentaux › Troubles neurocognitifs › Délire avec confusion › The impact of rounds with a psychiatry team in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › The impact of rounds with a psychiatry team in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Projets pilotes › The impact of rounds with a psychiatry team in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Morbidité › Incidence › The impact of rounds with a psychiatry team in...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Post-cure › The impact of rounds with a psychiatry team in...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Sortie du patient › The impact of rounds with a psychiatry team in...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › The impact of rounds with a psychiatry team in...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › The impact of rounds with a psychiatry team in...