Delirium – Plan for appropriate discharge

A follow up plan is important because:

Delirium can be the first sign of preexisting cognitive impairment and is associated with long-term cognitive decline

Patients with delirium have worse outcomes in the hospital (length of stay, mortality) and post hospital setting (falls, new functional dependence, SNF admission)

Patients with delirium discharged to skilled nursing facilities are more likely to have complications, rehospitalizations, and death

Consider outpatient cognitive and geriatric evaluation

An outpatient geriatric evaluation can evaluate a new cognitive baseline and work to optimize function

At Duke University:

Disposition:

The hospital is deliriogenic and patients should go to a post-acute care when medically stable

Consider a skilled nursing facility if there is a new functional deficits or skilled nursing need

Patients who can otherwise return home will often need supervision to ensure safety

Discharge instructions:

Consider providing guidance (if applicable) regarding driving, medication administration, managing finances

Include delirium on the discharge summary with instructions to reevaluate mental status

If on delirium antipsychotics:

Ensure plan is in place to taper, discontinue, or reevaluate on discharge to ensure to the lowest effective dose for the shortest duration