Proposal for Implementation of a Hospital Elder Life Program for the Prevention of Delirium at a Veteran's Administrative Hospital in the Intermountain West

This scholarly project was the development and presentation of a business plan proposing the implementation of the Hospital Elder Life Program (HELP), for the prevention of delirium, in hospitalized veterans aged 65 years and older. The business plan presented data specific to the Veterans Administration Hospital in Salt Lake City and overview of HELP intervention. The presentation of the business plan was presented to the Director of Geriatrics at the George E. Wahlen Veterans Department of Veterans Affairs Medical Center (VASLCHCS). Delirium is a common, yet serious, complication that occurs in hospitalized, older adults. The incidence varies from 20-82%, but often goes unrecognized in 72% of patients. There are multiple risk factors that increase vulnerability to developing delirium and Veterans, age 65 years and older, are at greater risk than the general population, due to higher incidences of comorbidities and mental health disorders. Hospitalization can precipitate delirium with the addition of new medications, immobilization, sleep disturbances, and unfamiliar environments. Delirium increases morbidity and mortality, causes declines in cognitive and physical function, prolongs hospitalization, increases likelihood of discharge to a skilled nursing facility, and increases healthcare expenditures. The objectives of this project were 1) to determine the incidence and risk factors of delirium in Veteran populations, 2) obtain statistical data specific to the VASLCHCS, 3) to prepare a business plan and presentation proposal for implementation of HELP for prevention of delirium at VASLCHCS, 3) to present the business plan and proposal to the Geriatric Division at the VASLCHCS, and 4) to disseminate project information. A literature review was conducted to guide this project. Topics of research included delirium and its characteristics, risk factors, incidence in the general and veteran populations, and Post Traumatic Stress Disorder (PTSD) as a risk factor for delirium. The consequences of delirium, for both patients and facility, were reviewed. Delirium prevention methods were researched to determine efficacy and HELP evaluated as a multicomponent prevention intervention. The implementation components of this project were data collection, development of business plan and presentation, and proposal of the business plan. Demographic and statistical data, from fiscal year 2015, were obtained from VASLCHCS, synthesized, and used for financial analysis. A business plan and presentation, proposing the implementation of HELP to prevent delirium, were developed. The business plan and proposal were presented to the Director of Geriatrics at VASLCHCS. The project was evaluated based on the completion of the business plan and presentation, not on the decision to implement the HELP at VASLCHCS. Delirium is a serious complication in hospitalized, older adults, and the presence of PTSD increases the risk. The subsequent outcomes of delirium are detrimental to the patient and increase health care expenditures, and are preventable. HELP is a multicomponent intervention proven effective in preventing delirium. This project was the development of a business plan proposing the implementation of HELP to reduce the incidence of delirium at VASLCHCS.