Authors' objectives: To assess the benefit of delirium unit in improving outcomes among delirious geriatric patients as delirium usually results in prolonged length of hospital stay with increased morbidity and cost of care.

Authors' results and conclusions: Limited fair level of evidence that suggest delirium unit significantly shortened the duration of delirium. In one controlled trial, it was shown that duration of delirium was significantly longer during pre-intervention period. On the contrary, the concurrent control group showed shorter duration. However, number of subjects included in both pre-intervention period and control were very small when compared to the intervention group. Only two studies with very small sample size have reported on the proportion of patients with recovery from delirium at ward discharge, which was noted to be significantly higher in the intervention group. Most studies reported no significant difference in the length of stay between the intervention groups and control groups. Results from one study of good quality reported there was a significantly longer length of stay among delirious subgroup in the intervention unit when compared to control groups. Similarly, higher quality studies reported no significant difference in in-hospital mortality outcome when comparing delirium room to control group. Only one study of fair quality mentioned significant improvement in in-hospital mortality after the introduction of delirium unit, and reduction trend was observed in some of the studies. Additionally, no significant difference was observed in patient falls rate between the intervention and control groups, though some studies have noted reducing trend of the risk in the intervention group. A significant reduction in nosocomial infection and lower pressure ulcer rate, as well as improvement in functional status were observed in the intervention group when compared to the historical group, however, these outcomes were only assessed in one study. A trial-based economic evaluation showed a trend towards cost saving and reasonable probability of CE despite no significant improvement in health status observed with delirium unit. No retrievable evidence on the safety of delirium unit or other unit/ room/ ward with similar purpose. Additionally, multicomponent strategies for better management of delirious geriatric patients were employed in all studies mentioned in this review. The setup of the intervention unit has taken into consideration various aspects such as ward environment and room design, human resources, standardised treatment protocol, and staff education.

Authors' recommendations: Multicomponent interventions for managing delirium in geriatric patients may be adapted to the current clinical settings for the provision of a better quality of care. In view of the limited availability of good quality evidence, a well-planned delirium unit may be implemented as a pilot project to obtain local outcome data.

Authors' methods: A systematic review was conducted. Review protocol and search strategy was developed by the main author and Information Specialist. The following electronic database was searched through the Ovid interface: Ovid MEDLINE® In-Process & Other Non-Indexed Citations and Ovid MEDLINE® 1946 to February 19, 2021. Parallel searches were run in PubMed, Cochrane Library – Database of Systematic Review and INAHTA database. While no limits were applied during search, only full text articles in English and published in 2010 onwards are included in the review. Additional articles were identified from reviewing the references of retrieved articles. The last search was performed on 23rd February 2021.

Authors' identified further research: More larger sample size studies that investigate on the improvement of scores for severity of delirium, patient falls rate, pressure ulcer rate, rate of aspiration pneumonia, use of physical restraint, as well as patient and carer satisfaction.

Project Status: Completed

Year Published: 2021

URL for published report: https://www.moh.gov.my/index.php/database_stores/store_view_page/30/375

Requestor: Ministry of Health, decision-making committee

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment

Contact Address: Malaysian Health Technology Assessment Section, Ministry of Health Malaysia, Federal Government Administrative Centre, Level 4, Block E1, Parcel E, 62590 Putrajaya Malaysia Tel: +603 8883 1229

Contact Name: htamalaysia@moh.gov.my

Contact Email: htamalaysia@moh.gov.my

Copyright: Malaysian Health Technology Assessment Section (MaHTAS)