Two-thirds of patients in intensive care units (ICU) develop delirium, and half of those who leave the ICU later suffer from a debilitating dementia-like illness. But now there are techniques that can improve these outcomes if they are incorporated into the day-to-day care of patients in the ICU.
A multidisciplinary team of researchers and health professionals at the University of Nebraska Medical Center has received a $300,000, 18-month grant to test and disseminate a program to improve the care of adults in the ICU. The study will be conducted in the ICU of UNMC's hospital partner, The Nebraska Medical Center.
The overall goal of the project is to educate health professionals on how to effectively screen, prevent and treat ICU delirium.
UNMC is one of six sites in the country to receive a grant from the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. The foundation created the initiative to address gaps in knowledge about nursing’s effect on quality of care and to leverage opportunities for research that would identify nurses’ contributions to improving patients’ health and safety.
Delirium, often referred to as "acute confusion," is a common, deadly and devastating condition that sometimes develops while a patient is hospitalized. Even after leaving the hospital, patients with delirium are at risk for dying and needing nursing home care.
The grant will be led by Michele Balas, Ph.D., assistant professor at the UNMC College of Nursing, and William Burke, M.D., professor at the UNMC College of Medicine Department of Psychiatry.
“When patients are confused or sedated, they can’t tell you what’s wrong,” Dr. Balas said. “That makes diagnoses difficult. It also contributes to this vicious cycle where confusion leads to the administration of sedation, which makes patients weaker and puts them at risk for pneumonia and infections. This sometimes requires them to go on a ventilator. This cycle, we believe, contributes to deaths that could potentially be prevented.”
Researchers will evaluate 900 patients in a delirium screening, prevention and treatment program developed at Vanderbilt University that is known as the Awakening-Breathing Coordination, Delirium Monitoring/Management & Early Mobility (ABCDE) program. The program is a multi-component program that uses tested interventions to improve the outcomes of critically ill adults.
“As health professionals, we’ve thought delirium was benign — something that we didn’t need to worry about and something that would go away, but we now know this is absolutely not the case,” Dr. Balas said.
Nurses, physicians, respiratory and physical therapists, and pharmacists all will be involved in the development and implementation of the project.
“This is a unique opportunity to study an intervention that has the potential to impact the short and long-term health of our patients,” Dr. Burke said. “This project will monitor how a new approach to delirium care is instituted and what the impact is on providers and the institution. This is an excellent example of translational research and a model for future studies.”
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