By Divya Chander, M.D., Ph.D., CharmHealth Evangelist
LinkedIn: Divya Chander
LinkedIn: CharmHealth
Despite being one of the most common, costly and deadly syndromes that patients encounter, delirium is not talked about enough. As a new generation of detection technologies emerges, my hope is awareness and treatment become part of our collective consciousness. Why is this so important?
Delirium can be a final common pathway or a biomarker for organ failure in one’s body. Patients’ brains are functionally breaking down. To put the scope and scale of the problem into perspective, if a patient is over the age of 65 and goes into the intensive care unit, his or her chance of developing delirium is a staggering 70% to 80%. Additionally, those who have untreated delirium die at three times the rate of all causes. If they don’t die prematurely, they may still accelerate the development and full expression of dementia by up to 20 years.
These are obviously outcomes we don’t want to see. Yet, as is often the case, one of the biggest drivers of change across the healthcare spectrum is money. As such, let’s look specifically at delirium’s economic impact.
Hard Costs
Delirium costs the U.S. healthcare system an estimated $254 billion annually, a figure quickly closing in on diabetes spending (which accounts for one out of every four dollars spent on healthcare). And because the onset of delirium is often tied to a surgical procedure or hospital stay, the patient’s average cost of care can balloon by $17,000-$22,000.
Additionally, researchers found that because the mortality rate is much higher for patients with delirium in the ICU, the death of those patients masks associated treatment costs. In fact, they project that, “If mortality among patients experiencing delirium were to be eliminated, the cost of delirium could be over 20% higher.” This speaks to both the increased risk of premature death and the costs of treatment.
What accounts for these costs? Simplistically, most patients with untreated delirium will require an extended hospital stay. They will also likely need post-acute care in a nursing facility. There could be associated complications or a need for memory care due to the acceleration of dementia symptoms. Bills can quickly skyrocket for patients, their families, and the insurance companies that cover them, and they continue to build with long-term care.
Impact of Early Detection
If delirium is identified and treated early, however, costs drop dramatically, and everyone experiences a better outcome. Here’s how:
- Patients: Anything that can reduce the mortality rate is a good thing. Studies show that early detection and treatment of delirium can lead to a 25%-40% reduction in mortality rate, depending on the study. Additionally, the dramatically improved quality of life and functional outcomes make a tremendous difference to patients and their families on both an emotional and financial level. On top of this, early detection can lead to a shorter hospital stay by 4-6 days, decreasing the cost of the patient’s care in a meaningful way.
- Providers and Hospitals: Doctors want the best possible outcome for their patients. With early detection and effective treatment, patients have far better outcomes. This can lead to much higher satisfaction scores from patients and their families as well as better quality metrics, Medicare reimbursement rates, and 30-day readmission rates. Additionally, by treating delirium from the onset, hospitals and providers can reduce their liability exposure (delirium-related malpractice claims average $380,000) — all while reducing the demands on resources.
- Healthcare Payers: Shorter hospital stays and reduced readmission rates clearly translate to lower overall costs for insurance carriers. But what can be more important to payers is avoiding malpractice or wrongful death claims in the event a patient dies due to delayed diagnosis or treatment. Early detection is one of the most cost-effective strategies over the long term for insurers.
And these are just some of the cost-related benefits. By recognizing delirium as a major comorbidity, and its impact on the entire healthcare system, better treatment options and outcomes can be experienced.
How to Advance Delirium Care
Several strategies can be implemented to improve delirium recognition and treatment. These include but are not limited to:
- Raising Awareness: Delirium will most likely touch the lives of those around us. Nearly half of people I engage with have personally experienced delirium or witnessed it in a family member. If a friend or loved one has a grasp of what delirium is and how it can present, if they know what to look for or what could be out of character for a patient they’re visiting, they can raise concerns to care teams early. Similarly, with greater awareness, care teams may become more consistent about screening and stay on guard for any signs of delirium becoming apparent.
- Leveraging Technology: Innovations such as edge computing, AI, and bioelectronic sensors are advancing the ability to monitor brain activity continuously. These tools can identify the functional breakdown of the brain before symptoms become evident to healthcare providers. Unlike traditional bedside exams, continuous monitoring captures the waxing and waning nature of delirium, which can expedite intervention. When systems are integrated and intelligence is incorporated, anomalies can be analyzed in real time.
- Investing in Research: Delirium is a highly complex syndrome that remains a mystery in some respects. By uncovering and understanding its root causes, diagnostic tools and treatments can become more precise and new protocols can be developed.
- Modifying Reimbursement Models: Recognizing delirium as a major comorbid condition may help incentivize hospitals to prioritize its management. Policies should align with the principle that improving patient outcomes can also drive financial sustainability.
Much can be done to advance the diagnosis and care of patients with delirium to not only save lives and improve quality of life but also to lower costs and reduce undue burdens on our healthcare system and stakeholders. Early detection will ultimately serve as our best weapon.