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Quality of care in hospitalized cancer patients before and after implementation of a systematic prevention program for delirium: the DELTA exploratory trial

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Abstract

Background

We evaluated whether the DELirium Team Approach (DELTA) program—a systematic management program aimed at screening high-risk groups and preventing delirium—would improve quality of care in patients hospitalized with cancer.

Methods

A retrospective before–after study was conducted during a pre-intervention period (between October 2012 and March 2013) and a post-intervention period (between October 2013 and March 2014) at a Japanese hospital providing specialized treatments for cancer. A total of 4180 inpatients were evaluated before the implementation of the DELTA program and 3797 inpatients were evaluated after implementation.

Results

After program implementation, the incidence of delirium decreased from 7.1 to 4.3% (odds ratio [OR], 0.52; 95% CI, 0.42–0.64). The incidence of adverse events, including falls or self-extubation, also decreased, from 3.5 to 2.6% (OR, 0.71; 95% CI, 0.54–0.92). There was a significant decrease in the prescription of benzodiazepines (OR, 0.79; 95% CI, 0.71–0.87), increase in the level of independence in activities of daily living at discharge (OR, 1.94; 95% CI, 1.11–3.38), and decrease in the length of stay (risk ratio 0.90; 95% CI, 0.90–0.90).

Conclusions

The systematic management program for delirium decreased the incidence of delirium and improved several clinical outcomes. These data suggest that this simple cost-effective program is feasible and implementable as routine care in busy wards.

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Acknowledgments

We are grateful to the staff who assisted in the program management, including Ms. Junko Ueda, Ms. Tomoko Nishimura, Dr. Hiroyuki Nobata, Dr. Yoshio Iwata, Ms. Yasuko Uchimura, and Ms. Kana Toyonaga, and to the staff in the Department of Nursing at the National Cancer Center Hospital East.

Funding

This work was supported by the National Cancer Center Research and Development Fund and by Japan Agency for Medical Research and Development Grants for Practical Research for Innovative Cancer Control, Grant Number 16ck0106216h0001.

Author information

Authors and Affiliations

  1. Psycho-Oncology Division, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Asao Ogawa & Yusuke Kanno

  2. Department of Psycho-Oncology Service, National Cancer Center Hospital East, Kashiwa, Japan

    Asao Ogawa & Daisuke Fujisawa

  3. Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan

    Yasuyuki Okumura

  4. Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan

    Daisuke Fujisawa

  5. Department of Psycho-Oncology, Kumamoto Red Cross Hospital, Kumamoto, Japan

    Hiroyuki Takei

  6. Department of Nursing, National Cancer Center Hospital East, Kashiwa, Japan

    Chiyuki Sasaki, Asuko Sekimoto & Chie Asanuma

  7. Research Management and Administration Section, Office of Management and Planning, Osaka University, Osaka, Japan

    Kei Hirai

  8. Department of Psycho-Oncology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan

    Kensuke Higa

  9. Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan

    Yasuhiko Ichida

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  1. Asao Ogawa
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Corresponding author

Correspondence to Asao Ogawa.

Ethics declarations

Research ethics and patient consent

This study was conducted in accordance with the amended Declaration of Helsinki and was approved by the Ethical Committee of the National Cancer Center, Japan (2014-028, approval no.: 2014-028). The full protocol is available from the corresponding author.

Conflict of interest

The authors declare that they have no conflict of interest.

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Ogawa, A., Okumura, Y., Fujisawa, D. et al. Quality of care in hospitalized cancer patients before and after implementation of a systematic prevention program for delirium: the DELTA exploratory trial. Support Care Cancer 27, 557–565 (2019). https://doi.org/10.1007/s00520-018-4341-8

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