To what extent will the annual number of episodes of acute confusion within a medical unit be reduced following the introduction of high risk indicators and early intervention strategies

To what extent will the annual number of episodes of acute confusion within a medical unit be reduced following the introduction of high risk indicators and early intervention strategies

This simple quantitative descriptive case controlled research compared cases (subjects at risk for acute confusion) with controls (subjects without the attribute); comparison was made on the exposure to potential contributing factors suspected of causing acute confusion, for example, heavy smoking, or the number of alcoholic drinks consumed per day. Case-control studies were also retrospective, because they focused on conditions in the past that might have caused subjects to become cases, rather than controls. The basic purpose of this research design was essentially the same as that of experimental research: to determine the relationships among variables. This report demonstrates that, with relatively good adherence by the nursing team, proactive screening using a structured risk assessment protocol can be successfully implemented for medical patients. This assessment was associated with a statistically significant 50 per cent reduction in the incidence of acute confusion in the intervention group, compared with usual care retrospectively. Reduction in acute confusion was not associated with shortened length of stay, but length of stay was often predetermined by protocol or critical pathway. Correlation analysis demonstrated that risk screening appeared most effective in preventing or reducing acute confusion in patients without preadmission dementia or ADL impairment. In patients with significant preadmission impairment, the stress of hospitalisation may be sufficient to precipitate an episode, despite otherwise optimal management. Less-impaired patients may require additional insults to precipitate acute confusion, some of which are avertable by risk screening and subsequent early intervention. Determined risk indicators were consistent throughout the four year timeframe set for this research project. This demonstrated that although there were multiple patient types presenting to this clinical area, they were consistently the same over a longitudinal timeframe. It meant they were reproducible, which gave this research additional strength. Also, based on the descriptive statistics, this research has shown that in this clinical area where intervention was introduced the combination did have a positive impact on annual numbers of acute confusion. In summary, these findings suggest that without risk screening and the direction for appropriate management the likelihood of an episode can more than double. In the three subgroups expected to pose the greatest challenges for the risk assessment (i.e. those 70 years or older, those with suspected drug dependency, and those with symptomatic infection), risk assessment retained excellent sensitivity, (a) (d) specificity, and relevant correlation with reduction of episodes. This research has demonstrated throughout that high risk screening and associated intervention based on the risk indicator can decrease the annual number of actual episodes of acute confusion. Interventions to prevent or reduce an episode of acute confusion, as outlined by Wakefield (2002) and this research, definitely increases as a result of high risk screening. Beyond doubt, from both the literature reviewed and the findings of this research, is that risk screening does need to be adapted to the individual clinical setting and cannot be generic.