Blue Cross funded anesthesiology pilot addressing efforts to combat delirium goes national with federal grant: expanding efforts to benefit vulnerable patients in healthcare settings

Imagine entering a hospital for routine care only to be overwhelmed by confusion and disorientation, finding it difficult to remember where you are, who’s caring for you or what you’re being treated for. This is delirium, a mental state defined by confusion and disorientation, especially common among older adults who enter the hospital for care— whether it be routine or emergency. Delirium can sometimes be prevented by utilizing approaches that help protect the brain. However, these prevention strategies are entirely dependent on identifying patients at risk for delirium.

Enter ASPIRE, Anesthesiology Performance Improvement and Reporting Exchange, the longstanding Blue Cross-sponsored statewide Collaborative Quality Initiative that has engaged Michigan’s anesthesiologist community on a variety of quality improvement efforts over the years. ASPIRE developed a two-year program, Improving Delirium Detection during Inpatient Admission, led by anesthesiologist Phillip Vlisides, M.D., and funded by Blue Cross. The objective was to improve delirium screening to identify vulnerable patients, mitigating the risk of delirium and related complications.

The ASPIRE team trialed three screening tools that detect delirium. These included the 4AT, the Nursing Delirium Screening Scale, and the Confusion Assessment Method standard. A survey was conducted with nurses to determine experiences and preferences between delirium screening tools, and the results demonstrated that most nurses believed that linking positive delirium screens to pager alerts for the primary care team served as a motivating factor to continue screening and recording positive screens. The choice of delirium screening tools also varied among nurses, with CAM being the top choice, followed by the NuDesc.

With this program, positive delirium screening rates significantly increased. Hospital nurses across Michigan were able to successfully and independently identify and chart delirious patients who required additional health care services. ASPIRE’s work on this project culminated with the submission and awarding of a national Patient-Centered Outcomes Research Institute award of more than $13 million to further propel efforts to positively impact delirium care for hospitalized patients.

Now the project has transitioned to the longer PCORI-funded trial.​The Hospital Elder Life Program versus Family-Augmented HELP for Prevention of Delirium, currently in progress and in the recruiting stage, will test whether family (and care partner) involvement at the bedside will help reduce risk of delirium in older, hospitalized patients. Dr. Sharon Inouye (Dual-PI, Hebrew Senior Life, Harvard Medical School) and Dr. Phillip Vlisides (Dual-PI, University of Michigan are leading the trial. Blue Cross serves as a stakeholder partner for the PCORI-funded program.

One approach for applying delirium prevention strategies is called the Hospital Elder Life Program. This program has proven effective in more than 20 studies to date. However, it is unknown whether involving family members (or care partners) along with hospital staff in HELP —through a new program called FAM-HELP — could improve preventing delirium. The traditional HELP Program will be compared to the new FAM-HELP Program in the PCORI-funded Evaluating Novel Healthcare Approaches to Nurturing and Caring for Hospitalized Elders Trial, which was launched in December 2023.

Outcomes of this PCORI-funded research could help hospitals, health insurance and health care leaders nationwide make decisions about effective delirium prevention programs to put into place in hospitals. The research team is working with eight hospital sites across the country to enroll adults ages 70 and older admitted to the hospital for acute care. In half of the group, the team will also enroll their family members or care partners into the FAM-HELP program.

HELP is already in place as standard care in the eight participating hospital sites and uses hospital staff and trained volunteers to provide interventions to help protect the brain. These interventions include reviewing daily orientation boards, providing fun activities the patient chooses to stimulate the brain, offering walking and exercises, helping with meals, encouraging sleep at bedtime without medications, and encouraging the use of glasses, magnifiers or hearing aids as needed. FAM-HELP will test a family/care partner-augmented version of this program.

The results of this study will be beneficial to understanding these prevention strategies and how families and care partners could play a role in their loved one’s care. Coupled with the advances in identifying delirium from the first part of ASPIRE’s Blue Cross-funded program, quick identification of delirium symptoms in older adults will help prevent many from experiencing it during their care, getting them back on their feet more efficiently and without additional strain on their families or hospital resources.

Additional resources can be found on the PCORI website.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.