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首页> 外文OA文献 >A pragmatic study exploring the prevention of delirium among hospitalized older hip fracture patients: Applying evidence to routine clinical practice using clinical decision support
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A pragmatic study exploring the prevention of delirium among hospitalized older hip fracture patients: Applying evidence to routine clinical practice using clinical decision support

机译：一项实用的研究探讨在住院的老年髋部骨折患者中预防ir妄的作用：使用临床决策支持将证据应用于常规临床实践

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Delirium occurs in up to 65% of older hip fracture patients. Developing delirium in hospital has been associated with a variety of adverse outcomes. Trials have shown that multi-component preventive interventions can lower delirium rates. The objective of this study was to implement and evaluate the effectiveness of an evidence-based electronic care pathway, which incorporates multi-component delirium strategies, among older hip fracture patients. We conducted a pragmatic study using an interrupted time series design in order to evaluate the use and impact of the intervention. The target population was all consenting patients aged 65 years or older admitted with an acute hip fracture to the orthopedic units at two Calgary, Alberta hospitals. The primary outcome was delirium rates. Secondary outcomes included length of hospital stay, in-hospital falls, in-hospital mortality, new discharges to long-term care, and readmissions. A Durbin Watson test was conducted to test for serial correlation and, because no correlation was found, Chi-square statistics, Wilcoxon test and logistic regression analyses were conducted as appropriate. At study completion, focus groups were conducted at each hospital to explore issues around the use of the order set. During the 40-week study period, 134 patients were enrolled. The intervention had no effect on the overall delirium rate (33% pre versus 31% post; p = 0.84). However, there was a significant interaction between study phase and hospital (p = 0.03). Although one hospital did not experience a decline in delirium rate, the delirium rate at the other hospital declined from 42% to 19% (p = 0.08). This difference by hospital was mirrored in focus group feedback. The hospital that experienced a decline in delirium rates was more supportive of the intervention. Overall, post-intervention there were no significant differences in mean length of stay (12 days post versus 14 days pre; p = 0.74), falls (6% post versus 10% pre; p = 0.43) or discharges to long-term care (6% post versus 13% pre; p = 0.20). Translation of evidence-based multi-component delirium prevention strategies into everyday clinical care, using the electronic medical record, was not found to be effective at decreasing delirium rates among hip facture patients.
机译：6妄发生在多达65％的老年髋部骨折患者中。医院出现ir妄与各种不良后果有关。试验表明，多组分预防性干预措施可以降低del妄发生率。这项研究的目的是在老年髋部骨折患者中实施和评估循证电子护理途径的有效性，该途径结合了多组分ir妄策略。我们使用中断的时间序列设计进行了务实的研究，以评估干预措施的使用和影响。目标人群是在阿尔伯塔省卡尔加里的两家医院接受了急性髋部骨折入院的所有同意接受治疗的65岁以上的患者。主要结局是del妄发生率。次要结果包括住院时间长，医院内跌倒，院内死亡率，长期护理的新出院和再次入院。进行了Durbin Watson检验以检验序列相关性，并且由于未发现相关性，因此适当地进行了卡方统计，Wilcoxon检验和逻辑回归分析。研究完成后，在每家医院进行了焦点小组讨论，探讨了有关使用命令集的问题。在40周的研究期内，共有134名患者入组。干预对总体ir妄发生率没有影响（前33％对后31％； p = 0.84）。但是，研究阶段与医院之间存在显着的相互作用（p = 0.03）。尽管一家医院的ir妄率没有下降，但另一家医院的the妄率却从42％下降到19％（p = 0.08）。医院的这种差异反映在焦点小组的反馈中。 del妄发生率下降的医院更支持干预措施。总体而言，干预后的平均住院时间（术后12天与术前14天； p = 0.74），跌倒（术后6％与术前10％； p = 0.43）或出院至长期护理无显着差异。 （发布后6％，而发布前为13％； p = 0.20）。没有发现使用电子病历将循证的多成分del妄预防策略转换为日常临床护理对降低髋关节骨折患者的ir妄发生率有效。

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