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Understanding the association between admission source and in-hospital delirium: a cross-sectional study
  1. Meghan K Thomas1,
  2. Marc E Heincelman1,
  3. Jingwen Zhang1,
  4. Justin Marsden1,
  5. Jennifer Dulin1,
  6. Patrick Robbins2,
  7. Kelly Hunt3,
  8. Patrick Mauldin1,
  9. William P Moran1,
  10. Benjamin Kalivas1,4
  1. 1Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3Public Health, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Meghan K Thomas, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; andersmk{at}musc.edu

Abstract

Patients admitted via interhospital transfer (IHT) experience increased risk-adjusted mortality, adverse events, length of stay, and discharge to facility; however, the etiology is not well understood. We hypothesize that IHTs are more likely to experience in-hospital delirium as compared with admissions to the hospital via the emergency department (ED) and clinic. This is a cross-sectional study of all adult admissions to medical, surgical, neurological, and obstetrics and gynecology services at an academic medical center who were screened for delirium between August 2018 and January 2020. Unit of analysis was admission source (IHT vs ED vs clinic) as the independent variable and the primary outcome was in-hospital delirium, assessed with initial brief confusion assessment method (bCAM) screening. 30,100 hospitalizations were included in this study with 3925 admissions (13.0%) screening positive for delirium at the initial bCAM assessment. The prevalence of delirium was much higher in IHTs at 22.3% (1334/5971) when compared with clinic at 5.8% (244/4214) and ED at 11.8% (2347/19,915) admissions. Multivariable logistic regression adjusting for demographics and comorbidities showed that IHT admissions had higher odds (OR 1.91, 95% CI 1.74 to 2.10) and clinic admissions had lower odds (OR 0.56, 95% CI 0.48 to 0.64) of in-hospital delirium compared with ED admissions. Increased odds of delirium in IHT admissions may contribute to the observed increased length of stay, discharge to facility, and mortality. These results emphasize the importance of routine screening and possible intervention prior to patient transfer.

  • Cognition
  • Hospitals
  • Inpatients

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Presented at Preliminary findings were presented at the 2021 Society of General Internal Medicine National Conference as a poster presentation.

  • Contributors MKT: study concept and design; acquisition, analysis and interpretation of data; drafting and revising the manuscript for important intellectual content; final approval of the published version; agreement to be accountable for the work related to accuracy and integrity; guarantor and accepts full responsibility for the completed work and the conduct of the study, had access to the data, and controlled the decision to publish. MEH, WPM: study concept and design; interpretation of data; revising the manuscript for important intellectual content; final approval of the published version; agreement to be accountable for the work related to accuracy and integrity. JZ: study design; acquisition, analysis and interpretation of data; drafting and revising the manuscript for important intellectual content; final approval of the published version; agreement to be accountable for the work related to accuracy and integrity. JM: study design; acquisition and analysis of data; revising the manuscript for important intellectual content; final approval of the published version; agreement to be accountable for the work related to accuracy and integrity. JD: study concept; acquisition and interpretation of data; revising the manuscript for important intellectual content; final approval of the published version; agreement to be accountable for the work related to accuracy and integrity. PR: study concept; interpretation of data; revising the manuscript for important intellectual content; final approval of the published version; agreement to be accountable for the work related to accuracy and integrity. KH, PM: study concept and design; acquisition, analysis and interpretation of data; revising the manuscript for important intellectual content; final approval of the published version; agreement to be accountable for the work related to accuracy and integrity. BK: study concept and design; acquisition and interpretation of data; revising the manuscript for important intellectual content; final approval of the published version; agreement to be accountable for the work related to accuracy and integrity.

  • Funding This project was supported by the Health Resources and Services Administration (HRSA; grant number: T0BHP30003) of the US Department of Health and Human Services (HHS) as part of an award totaling $2,673,342.

  • Disclaimer The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the US Government. For more information, please visit HRSA.gov.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.