“To truly transform the way we care for our patients, we have to think and act differently,” says Mary-Lynn Peters, a nurse practitioner and project manager, Adult and Seniors Inpatient Delirium Project at Trillium Health Partners (THP). Peters is referring to new changes and improvement in a traditional health care system where for the first time mental health and physical care are being treated together, allowing patients access to timely services.
Delirium is a sudden and often temporary state of confusion. Delirium is different from dementia or Alzheimer’s disease as it develops quickly, may clear completely and can be prevented. For patients in hospital, delirium is typically caused by acute medical illness, metabolic abnormalities, infection, surgery, medications, alcohol or drug withdrawal, or even hospital practices (e.g. room changes and sleep disruption).
THP saw an opportunity to create a multi-pronged model of care that incorporates prevention, screening, management and transitions of care for patients at risk of delirium, or with delirium.
The primary goal of the model of care is to reduce the incidence of delirium, which leads to longer stays in hospital, a higher rate of cognitive decline, and an increased likelihood of admission to a nursing home.
“Delirium is very debilitating for patients and can be upsetting to families. To help prevent delirium we started a class for patients for at risk patients or those who are showing early signs,” says Candice Soares, an occupational therapist at THP. “The patients are taken to a space in the hospital with natural light and we spend time stimulating the brain through music and exercise. The changes we are seeing in our patients is incredible.”
In addition, through the creation of collaborative care model for delirium prevention and management, THP has helped launch a new model of care for adult and senior patients. An interprofessional Delirium Team made up of a nurse practitioner, occupational therapist, and physicians from medicine and psychiatry work together to treat the whole patient, both mentally and physically.
“Traditional care practices are very siloed and fragmented. The model of care gave the health care team new ways of working collaboratively to prevent and manage delirium,” says Peters. “Our primary goal is to prevent delirium from happening in hospital, and then work together as a team to treat the patient.”
With input from other health care organizations and based on review of the literature, Peters has worked with THP colleagues Dr. Jason Kerr, Division Head, Seniors’ Health, and Sarah Banbury, Director, Mental Health, to create universal delirium precautions and implement screening. When delirium is identified in a patient, the health care team on the unit is now using a collaborative approach to providing delirium care.
The early results from the model of care are promising, with over 2,500 patients screened for delirium from September 2016 to October 2017. Staff, patients and families have commented how the preventative measures and collaborative care approach are making a difference.
Supported by the Medical Psychiatry Alliance (MPA), a unique Canadian health partnership between THP, the Centre for Addiction and Mental Health, The Hospital for Sick Children, and the University of Toronto, the collaborative care mode has been in place at THP since September 2016. Initially piloted on one unit at THP the model of care has been so effective that it is now being used on other units and across the hospital.
“This model of care has demonstrated how specific education for front-line staff can lead to a meaningful change in how patients are cared for within the hospital,” says Dr. Jason Kerr, who is also Physician Lead of the new delirium project. “We hope that this integrated and collaborative approach will be adopted by other health organizations within Ontario and beyond.”