Background: In-hospital delirium is associated with poor hospital outcomes, including longer hospital stays and increased morbidity. Nonpharmacological approaches have proven beneficial in reducing delirium occurrence by nearly 40%. Staffing shortages in healthcare have prompted the need for innovative strategies to prevent in-hospital delirium development. As such, we implemented a pilot program for delirium optimization with volunteering engagement (DOVE) to support nursing staff and provide nonpharmacological interventions for patients at risk for delirium.
Methods: Hospital volunteers were trained on risks, presentation, and nonpharmacologic interventions previously demonstrated to mitigate delirium development. These interventions included sensory aide assistance, completion of “get to know me” forms, conversation, and reorientation as appropriate. Interventions were guided towards patients identified as risk for delirium, based on delirium risk assessment (DRA) score. All patient interactions occurred within an in-hospital general medicine floor at Mayo Clinic, Rochester, MN between August 2023 and February 2024. Institutional Review Board approval was obtained to search patient medical records. The primary outcome was in-hospital delirium occurrence. Patient data and demographics were compared to a control cohort assembled from a separate in-hospital medical unit where volunteer interventions were not applied. Cohort matching was performed for age, gender, delirium risk assessment score on admission, month/year of admission, and hospital length of stay in a 2:1 ratio (controls:cases).
Results: A total of 168 patients, (77+11.3 years, n=77 female) underwent intervention by DOVE volunteers. Of this cohort, 65 patients (38.7%) developed delirium during the hospitalization. Following matching, 139 patients in the DOVE intervention cohort were matched with 261 controls. In-hospital delirium occurrence was lower in the DOVE intervention group compared to the control cohort (46.8% vs 56.7%; P=0.015). Conditional logistic regression demonstrated a significantly lower odds ratio (OR) for delirium occurrence 0.55 (95% CI = 0.34-0.89; P=0.015) associated with DOVE intervention. Subgroup analysis in patients with delirium risk assessment score of 3-4 demonstrated an OR of 0.56 (95% CI= 0.31-1.01; P=0.053), as opposed to OR 0.44 (95% CI= 0.15-1.25; P=0.124) for a delirium risk assessment score of 0-2, associated with DOVE intervention.
Conclusions: An innovative and practical DOVE pilot reduced delirium occurrence in hospitalized adults on the general medical unit. This finding highlights an opportunity for healthcare organizations to explore and leverage alternate practical resources, especially in the context of staffing shortages, to mitigate delirium occurrence.