The Mount Sinai Health System operates a novel program to identify and treat hospital delirium in ways unique to other hospital delirium programs in the country. Delirium is a rapid change in mental abilities; acute confusion manifested by disorientation, memory impairments, attention impairments, loss of ability to recognize family members and friends. Delirium is also associated with acute behavioral changes such as being withdrawn, sleeping all day, being up all night, being uncooperative with medical care, paranoid, aggressive. This rapid onset of confusion and behavioral disturbances is very distressing to family members and caregivers, interferes with the optimal delivery of medical and peri-operative care and is associated with poorer medical outcomes compared to patients who do not develop delirium. Delirium is often missed because many delirious patients are initially quiet and therefore the symptoms overlooked. Additionally, delirium is often times confused for psychiatric conditions such as depression, mania, schizophrenia, and dementia. Our program is effective at rapid and accurate identification of patients with delirium. Through technological innovations we have developed and clinically deployed a novel artificial intelligence based delirium risk prediction algorithm in our electronic hospital records system to identify those at risk for developing delirium. This allows our multi-disciplinary team to focus on the right patients and rapidly identify and treat those who have become delirious or at a very elevated risk for developing delirium.
We access and process a large volume of patient clinical information to provide a thorough and holistic approach to identifying and addressing all factors contributing to a patient’s delirium. These factors include undiagnosed medical conditions, peri-operative conditions, metabolic abnormalities, identification of medications potentially contributing to the delirium, hydration status, nutrition status, mobility, use of tethers which can be removed (i.e. catheters or physical restraints), mobility status, environmental conditions. These interventions are complemented by a person-centered care approach identifying unmet needs of the patients and addressing them, including: social isolation, lack of cognitive stimulation, sensory deprivation, unusual presentation of pain, addressing behaviors mistaken for pain. We expand our outreach by educating hospital staff and patient families who are encouraged to participate in the treatment of delirious patients.
The goal of our delirium program is to rapidly identify and initiate treatment of delirium in hospitalized patients in order to improve their recovery from their primary medical condition and/or surgery, reduce the length of time they need to spend in the hospital, enhance physical, cognitive and functional recovery after discharge, reduce the need for hospital readmissions, and allow patients to return to their homes and resume their lives.
Services We Offer
All patients identified in our electronic health records system as high risk for developing delirium receive formal assessments for the presence of delirium or the near onset of delirium (subsyndromal delirium) by extensively trained and experienced assessors. We use the confusion assessment method (CAM) in regular hospital patients and the Confusion Assessment Method–Intensive Care Unit for those patients in the intensive care units. When patients with delirium are identified:
- Medicine and surgical physicians and nursing staff on the patient’s primary team are alerted to the presence of a delirium or subsyndromal delirium diagnosis through an automated alerting system.
- Patients with delirium or subsyndromal delirium are added to active patient lists for the delirium service to follow these patients and their progress throughout their admission.
- Delirium service providers use initial findings and recommendations to provide a holistic approach to assist other health care providers to care for their delirious patients.
- Provide nursing staff caring for these delirious patients with delirium specific nursing care plans.
- Sensory support through hearing aids and magnifiers are provided to delirious patients following the assessment of visual and auditory acuity
- Create individualized person-centered treatments including cognitive and physically stimulating delirium interventions carried out by our highly trained and experienced staff.
Risk Factors for Delirium
While delirium can occur at any age, the geriatric population is particularly prone to delirium and its complications. Post-operative older adults are at special risk for developing delirium.
Typically, delirium is caused by some other medical illness, such as pneumonia or following surgery along with one or more of the following risk factors:
- Being bedbound or immobile
- Lack of stimulation, such as no access to the following:
- Calendar or clock to orient to time
- Familiar objects around to see
- Interaction with other people
- Loss of senses, such as hearing or visual problems
- Old age - 70 years and above
- Taking certain medications
Symptoms of Delirium
The symptoms of delirium can vary. Any combination of cognitive and behavioral changes can be present, including:
- Changes in every day behavior such as:
- Sleeping too much
- Not answering questions
- Not moving much
- Not eating
- Conversations that make no sense or speech that cannot be understood
- Hallucinations, such as seeing imaginary people or animals
- Illusions, such as thinking a coat on a chair is a person
- Not knowing the day, month, year, or where they are
- Not remembering why they are in the hospital, that you came to visit the previous day, or information you told them a few minutes ago
- Picking at clothing, trying to get out of bed without assistance, pulling out IVs, taking off clothes, yelling, trying to hit people
- Reduced awareness of the person’s surroundings and problems with attention, such as asking the same questions over, or giving the same answer over and over even though you are asking a different question, or the person may not be able to talk with you at all)
- Sleeplessness at night and sleepiness during the day
Treatments We Offer
Mount Sinai delirium program engages holistic delirium treatment plans tailored to meet individual patient needs by:
- Ensuring proper hydration and nutrition (food choice, assistance with meals when necessary)
- Helping the delirious person become active as quickly as possible, according to an assessment of their abilities by getting them out of bed and in a chair or walking with the assistance of physical therapy
- Identifying and quickly treating the underlying medical and/or surgical problems that are causing the delirium
- Lowering the dosage of or stopping those medications which can be associated with the delirium
- Providing medication only when necessary to treat dangerous behaviors (such as pulling out IV lines, hitting staff and family) and to treat hallucinations
- Reminding them of the date, time, place, who their hospital caregivers are, why they are in the hospital, what medications they are receiving and why. Update the orientation board in their room daily
- Removing tubing, such as urinary catheters as soon as possible
How You Can Help With the Delirium Treatment
- Make sure you, other family, friends, and caregivers visit the delirious patient as often as possible
- Bring things to the hospital to help with orientation (such as clock, calendar)
- Talk to the delirious patient, work on puzzle books, read, play games. Even when they are asleep they are listening.
Meet Our Team
The Mount Sinai multidisciplinary team uses innovative technologies that provide smart decision support to our team headed up by:
- Medical Director: Joseph Friedman, MD