Skip to content

Clay Angel, MD

Hospital Medicine, San Rafael

Delirium Management Program

“When you care for the fragile elderly, there are simple things you can do that make a big difference. The focused, back to basics approach toward elder care is what I really love about this program.”

Delirium affects up to half of hospitalized patients over age 65 and nearly 80% of patients in intensive care units. Patients suffer from confusion and other symptoms, and have a 22% greater risk of dying in the 6 months following hospitalization.

Many physicians consider delirium an inevitable occurrence among older patients in the hospital. Drs. Angel and Eberhardt were determined to address the problem.

Launched in San Rafael in 2010, the Delirium Management Program was developed in collaboration with colleagues in psychiatry, hospital medicine, emergency medicine and nursing. Using early identification, virtual multidisciplinary rounding and pharmacologic management, the program transformed the medical center’s approach from crisis intervention to proactive management.

Delirium management and prevention are designed to eliminate potential triggers. For example, because medications are a common and potent cause of delirium, there is a focus on avoiding certain drugs, and carefully titrating others.

One of the unique features of the Program is its relentless focus on evidence-based, non-pharmacologic strategies to help prevent and treat delirium. These include ensuring the patient’s assistive devices, such as dentures, hearing aids and glasses are available; encouraging frequent family visits to help orient the patient; and supporting sleep by turning off room lights by 10 p.m.

The Program’s multifaceted approach has been powerful. Between Sept 2010 and July 2012, the average length of stay among patients who experienced delirium at San Rafael decreased from 8.5 days to 6.5 days. “Patients and their families are happier when the hospital stay is shorter, and we found patients had fewer complications in the hospital and were less likely to be transferred to nursing homes when their stay was shorter,” notes Dr. Angel.

San Rafael’s Delirium Management Program is being rolled out to other hospitals in KP Northern California. It also is being shared with physicians around the country, in KP and in other hospital systems.

Back To Top