SHM Converge Scientific Abstract ePoster Gallery-The Effect of Delirium on Interhospital Transfer Outcomes: A Retrospective Cohort Study

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This retrospective cohort study examined whether delirium changes the effect of admission source—interhospital transfer (IHT) versus emergency department (ED) admission—on hospital outcomes.<br /><br />Researchers reviewed adult hospitalized patients at a single academic medical center from August 2018 to January 2020. Delirium was identified using the bCAM screening tool. The main outcomes were discharge to a facility, length of stay (LOS), and in-hospital mortality.<br /><br />The final study population included 30,100 patients. Compared with ED admissions, IHT patients were generally older and had more comorbid illness and higher rates of ICU use, antipsychotic exposure, and dementia. Delirium was associated with worse outcomes overall in both admission groups.<br /><br />Key findings showed that delirium amplified the impact of IHT on some outcomes. For discharge to a facility, IHT patients with delirium had the highest risk, suggesting a more than additive interaction between IHT and delirium. For mortality, delirium in IHT patients also showed a more than additive effect. For LOS, the interaction was additive: both IHT and delirium independently increased LOS, and their combined effect was roughly the sum of each alone.<br /><br />In adjusted analyses, compared with ED patients without delirium, the odds of discharge to a facility were higher for ED patients with delirium, IHT patients without delirium, and highest for IHT patients with delirium. Similar patterns were seen for LOS, and mortality was greatest among IHT patients with delirium.<br /><br />Overall, the study concludes that both IHT and delirium are associated with poorer hospital outcomes, and delirium modifies the effect of IHT on discharge disposition, LOS, and mortality. These findings highlight the need for early delirium recognition and targeted management, especially in transferred patients.

Asset Subtitle

Meghan K. Thomas

Meta Tag

Author List Benjamin Kalivas, Jennifer Dulin, Jingwen Zhang, Justin Marsden, Kelly Hunt, Marc Heincelman, Meghan K. Thomas, Patrick Mauldin, William Moran

Category Research

Concept Delirium

Concept Pediatric Inter-Hospital Transfer

Concept Hospital Outcomes

Concept Discharge to Facility

Concept Length of Stay

Distinguished Non-Finalist

Presenter Organization Medical University of South Carolina

Presenting Author Meghan K. Thomas

Track Transitions of Care

Keywords

delirium

interhospital transfer

emergency department admission

hospital outcomes

retrospective cohort study

length of stay

in-hospital mortality

discharge to facility

bCAM screening

adult hospitalized patients

Delirium

Pediatric Inter-Hospital Transfer

Hospital Outcomes

Discharge to Facility

Length of Stay