The impact of rounds with a psychiatry team in the intensive care unit: A prospective observational pilot study evaluating the effects on delirium incidence and outcomes

Katherine J Choi; Matthew Tan; Kelly Jones; David Sheski; Stephanie Cho; Thomas Garrick; Anita Yau; Donald Solio; Kimberly Sinclair; Elvin Cervantes; Rae Ann Castillo; Damon Clark; Subarna Biswas; Claudia Alvarez; Itamar Grunstein; J Perren Cobb; Catherine M Kuza

doi:10.1016/j.jpsychires.2023.02.011

The impact of rounds with a psychiatry team in the intensive care unit: A prospective observational pilot study evaluating the effects on delirium incidence and outcomes

J Psychiatr Res. 2023 Apr:160:64-70. doi: 10.1016/j.jpsychires.2023.02.011. Epub 2023 Feb 7.

Authors

Katherine J Choi¹, Matthew Tan², Kelly Jones³, David Sheski⁴, Stephanie Cho⁴, Thomas Garrick⁴, Anita Yau⁵, Donald Solio², Kimberly Sinclair², Elvin Cervantes², Rae Ann Castillo², Damon Clark⁶, Subarna Biswas⁶, Claudia Alvarez⁷, Itamar Grunstein², J Perren Cobb⁶, Catherine M Kuza⁸

Affiliations

¹ Division of Plastic and Reconstructive Surgery, University of California, Los Angeles (UCLA), 200 UCLA Medical Plaza, Suite 460, Los Angeles, CA, 90095, USA; Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.
² Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.
³ Department of Psychiatry, Hoag Hospital, 1 Hoag Dr, Newport Beach, CA, 92663, USA; . Department of Psychiatry, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.
⁴ . Department of Psychiatry, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.
⁵ Biostatistics, Epidemiology, and Research Design, Southern California Clinical and Translational Science Institute, University of Southern California, 1845 N. Soto Street, Los Angeles, CA, 90033, USA.
⁶ . Department of Surgery, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA.
⁷ . Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 333 City Blvd. West, Suite 1600, Orange, CA, 92868-3298, USA.
⁸ Department of Anesthesiology, Division of Critical Care, Keck School of Medicine of the University of Southern California, Keck Hospital of USC, 1500 San Pablo Street, Los Angeles, CA, 90033, USA. Electronic address: catherine.kuza@med.usc.edu.

PMID: 36774832
DOI: 10.1016/j.jpsychires.2023.02.011

Abstract

Background: Delirium in the intensive care unit (ICU) is a common but serious condition that has been associated with in-hospital mortality and post-discharge psychological dysfunction. The aim of this before and after study is to determine the effect of a multidisciplinary care model entailing daily ICU rounds with a psychiatrist on the incidence of delirium and clinical outcomes.

Objective: To assess the impact of a proactive psychiatry consultation model in the surgical ICU on the incidence and duration of delirium.

Methods: This was a prospective, single institution, observational controlled cohort pilot study of adult patients admitted to a surgical ICU. A control group that received standard of care (SOC) with daily delirium prevention care bundles in the pre-intervention period was compared to an intervention group, which had a psychiatrist participate in daily ICU rounds (post-intervention period). The primary outcome was delirium incidence. The secondary outcomes were: delirium duration, ventilator days, hospital and ICU length of stay, and in-hospital mortality.

Results: A total of 104 patients were enrolled and equally split between SOC and intervention groups; 95 contributed to analysis. The overall incidence of ICU delirium was 19%. SOC and intervention groups had similar rates of delirium (21% vs 18%, p = 0.72). None of the secondary outcomes statistically significantly differed between the two groups.

Conclusion: Delirium in ICU patients is a potentially preventable condition with serious sequelae. There was no difference in delirium incidence or duration between patients receiving SOC or patients who had multidisciplinary rounds with a psychiatrist.

Keywords: Critical care; Delirium prevention; Multidisciplinary care; Postoperative delirium.

Publication types

Observational Study
Research Support, N.I.H., Extramural

MeSH terms

Adult
Aftercare
Delirium* / epidemiology
Delirium* / prevention & control
Humans
Incidence
Intensive Care Units
Length of Stay
Patient Discharge
Pilot Projects
Prospective Studies

Grants and funding

UL1 TR001855/TR/NCATS NIH HHS/United States