A hospital-wide, evidence-based interprofessional care initiative can improve outcomes and cut readmissions for patients at risk for delirium, alcohol abuse and suicide harm (DASH), according to a study from the Joint Commission and Brigham & Women's Hospital (BWH) in Boston published in The Joint Commission Journal on Quality and Patient Safety.
DASH patients are at increased risk for readmission, but it is often difficult to address their health needs because they could be anywhere in the hospital, according to Barbara E. Lakatos, program director of the Psychiatric Nursing Resource Service at BWH and the lead author of the paper. That factor made it necessary to include the hospital's entire patient population in the research.
"If not appropriately identified and treated, delirium can lead to negative outcomes and poor quality of life for those affected," she said in a study announcement.
A research team that comprised physicians, nurses and psychiatrists developed a four-step process for DASH patients:
- Create guidelines
- Implement and roll out the principles
- Integrate the guidelines into practice
- Continue to develop and evaluate those practices
After developing the initiative's guidelines for care and screening, Lakatos and her team next integrated them into the hospital's clinical workflow, developing resources such as training videos, workshops and resource manuals. The team tailored its interventions to individual patients, convening the interdisciplinary care team to discuss best practices each time the hospital identified a patient as at high risk for DASH.
After implementing the program, Lakatos and her team compared outcomes before implementation to data from 2010 to 2013 after it began, assessing all DASH patients except those in the hospice and neonatal departments. While the overall DASH population increased 1 percent between 2012 and 2013, 30-day readmissions among those patients fell 9 percent during the study period, according to the study.
Despite these successes, the authors added, hospitals must integrate such interventions into their broader clinical culture to truly reap their benefits. To address patients at risk for suicide, hospitals must also increase mental health screenings and targeted interventions, FierceHealthcare previously reported.