Improving Delirium Detection and

Management During Inpatient

Admission

Phillip Vlisides, MD

Executive Director, Neuroscience Research

Department of Anesthesiology

Michigan Medicine

Ann Arbor, MI USA

Funding and Disclosures

• Funding: NIH/NIGMS K23GM126317; NIH/NCATS

NIH/NCATS UL1TR002240; NIH/NIA AG024824

• Other Disclosures: Blue Cross Blue Shield of

Michigan

A disturbance in attention and awareness,

developing over a short period of time,

that tends to fluctuate in severity during

the course of a day.

Delirium

Koster S et al. Ann Thorac Surg. 2012

• Common (10-70%)

• Increased mortality

• Cognitive decline

• Functional decline

• Healthcare costs ($33 billion annually)

Delirium

Gottesman RF et al. Ann Neurol. 2010

Saczynski JS et al. N Engl J Med. 2012

Gou RY et al. JAMA Surg 2021

Screening

1. Mixed methods

What are the challenges?

2. Pilot Implementation Trial

3. Healthcare costs and value

Management

• Reduced delirium incidence (OR 0.47, 95% CI 0.37 – 0.59)

• Fall rate reduced by 42% (OR 0.58, 95% CI 0.35 – 0.95)

• Saved $1600-$3800/patient in hospital costs, $16,000 per

person-year in terms of long-term costs

Conclusions

• >20 million inpatient surgeries per year (≥65 yo)

• Delirium cases:

• 2 million (10% incidence)

• 10 million (50% incidence)

• Increased morbidity, mortality, healthcare costs

Acknowledgements

Division of Perioperative Neuroscience

Amy McKinney

Joseph Brooks

Duan Li

Mackenzie Zierau

Maria Hill-Carruthers

George Mashour

Phil Vlisides

“If the human brain

were so simple that

we could understand

it, we would be so

simple that we

couldn’t.”

– Emerson M. Pugh