The HAC No One Wants to Talk About
In large hospitals, a program to reduce delirium in ICU patients, chiefly by reducing the amount of unneeded sedation, has cut rates of the condition in half. Soon it will be implemented in 60 more selected hospitals.
What serious hospital-acquired condition affects 25% of patients over age 70 and up to 82% of patients in the ICU?
I'll give you a few hints:
- It's not on Medicare's list of "never events," for which hospitals must forego federal reimbursement.
- It's not an infection that affects, urinary tract, or surgical sites, although patients with this condition may suffer those as well.
- It's not falls, pressure ulcers, blood clots, or mismatched transfused blood.
It's delirium, which Harvard aging researcher Sharon Inouye, MD, describes as "an acute disorder of attention and cognition that is common, serious, costly, under-recognized, and often fatal," with a collective healthcare price tag of more than $164 billion a year in the U.S.
Experts say it is often missed because it's frequently subtle, manifested with quiet symptoms like extreme sleepiness, non-responsiveness, or inattention.
But it also can appear—abruptly and surprisingly—in a more alarming way, with hallucinations and agitation. It's not uncommon that patients thrash in their beds, pull out their IVs, or appear to be fighting off an attack. They may see bugs on the wall or intruders in their rooms, or think a caregiver or family member's touch is a sexual assault.
Clinicians have tended to dismiss delirium as a normal occurrence in older people that will abate in time, but it isn't, and it often does not simply go away. The best way to treat it is to prevent it.