Delirium Best Practice Updates for Hospitalists-Slides

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This presentation by Dr. Sandeep Pagali from Mayo Clinic offers an overview of best practices in delirium care for hospitalists, emphasizing delirium identification, prevention, and management in hospitalized older adults.<br /><br />Delirium varies in prevalence across hospital settings (ICU, medical floors, ED) and manifests in hypoactive, hyperactive, mixed, and no-motor types. Prompt, accurate detection is critical, using validated screening tools tailored to care settings: CAM (5 min), CAM-ICU (2 min), 3D-CAM (3 min), and ultra-brief screens (1-2 min), such as the UB-2 test suitable during rounds. Risk prediction tools like the recalibrated Mayo Delirium Prediction Tool help allocate prevention resources effectively.<br /><br />Prevention relies primarily on multicomponent, team-based non-pharmacologic strategies targeting modifiable predisposing (e.g., sensory impairment, cognitive decline) and precipitating factors (e.g., infection, dehydration, polypharmacy). Delirium management must involve cause identification and reversal, harm prevention (falls, aspiration), family engagement, and goal-of-care discussions.<br /><br />Behavioral disturbances in delirium are managed using the DICE approach: Describe behaviors, Investigate cause, Create a plan, and Evaluate effectiveness. Safety protocols prioritize caregiver protection and environment modification.<br /><br />Pharmacologic therapy is reserved for severe agitation threatening safety, with low-dose antipsychotics used off-label. Evidence shows no benefit of antipsychotics in delirium prevention, duration, or severity reduction. Among antipsychotics, quetiapine and risperidone are preferred over haloperidol in Parkinsonism due to fewer extrapyramidal effects. Aripiprazole shows promise for hypoactive delirium with minimal QTc risk. Melatonin and suvorexant may reduce delirium incidence, especially in surgical and ICU patients.<br /><br />Hospitals should optimize delirium care pathways by reviewing screening tools and frequency, enhancing communication, leveraging technology for alerts and documentation, and forming multidisciplinary teams for quality improvement.<br /><br />In summary, delirium care emphasizes early detection, non-pharmacologic prevention, judicious medication use, behavioral management with DICE, and institutional process optimization to improve patient outcomes.
Keywords
delirium care
hospitalists
older adults
delirium identification
delirium prevention
delirium management
screening tools
non-pharmacologic strategies
DICE approach
pharmacologic therapy