Here’s how we’ll know when hospital safety and quality programs are working

Here’s how we’ll know when hospital safety and quality programs are working

If you’ve ever accompanied a friend or relative during a hospitalization, you know the patient is lucky to emerge with his or her life, even if they went in with something relatively minor. Lots of little things go wrong, or not quite right –wrong or skipped or mis-timed medication, medical staff not washing their hands, wrong food delivered and so forth. It’s almost always a harrowing experience as far as I can tell.

But lots of patients don’t have someone from the outside to look after them, and many patients experience delirium in the hospital, making it even harder for them to fend for themselves. See A practical program for preventing delirium in hospitalized elderly patients.

Delirium is a marker of poor hospital care for older people: it is associated with serious complications; it often goes unrecognized by physicians and nurses; and its occurrence is integrally linked with processes of hospital care, such as overuse of medications and iatrogenic events.

The estimated occurrence rates of delirium range from 14% to 56% during the course of hospitalization.

Hospital mortality rates of patients with delirium range from about 10% to 65%, more than twice as high as for matched controls. Thus, delirium has a case fatality rate as high as that of acute myocardial infarction or sepsis.

Rate of delirium and mortality rate of delirious patients are probably good metrics to track in evaluating a hospital’s overall safety and quality record.

Thanks to Mickey.

April 27, 2006

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