Ocala, FL – August 30, 2021 – Dr. A. Joseph Layon published an article in the BMJ Journals about Delirium, a form of acute brain dysfunction presenting as altered mental status, and impairment of memory, emotion, thinking, perception and behavior, which develops over hours to days and is seen in 20% – 80% of adult intensive care unit (ICU) patients, depending on the diagnostic method used and severity of illness.
Delirium diagnosis is often missed, as only about 25% of patients experiencing this disorder are hyperactive; more prevalent is hypoactive delirium: patients appearing sedated and responding slowly to instructions or questions. Rarer still, mixed hyperactive-hypoactive delirium patients may be seen. There is also subsyndromal delirium, representing an intermediate state—not normal and yet not fully developed delirium.
Delirium can lead to serious complications including increased length of ICU stay and increased readmission, institutionalization, and mortality rates. If not diagnosed or treated, delirium may lead to may lead to irreparable and delayed cognitive failure.
“The ICU Reader Program was born as a service project, using volunteers, in which we hoped to identify a decrease in delirium days — the ‘signal’ — that would prove, or at least suggest we were right about, our hypothesis,” stated Dr. Layon.
Readers were enrolled through the Volunteer Services Department, undergoing infection control and confidentiality training. The program was composed of 11 Readers, mostly high school and college students, and ran from January 2017 to August 2017; patient data analyzed for the study were collected between July and August 2017.
The program was designed and implemented and principally managed by Dr. Layon and his colleague, S. Jordan Reif, now a graduate student.
Students were recruited due to their willingness to volunteer. Each day, the volunteer asked the ICU Charge Nurse which patient they felt would be most suitable for reading and/or companionship.
Readers would then ask the patient — or surrogate if the patient was unable to interact — if they desired to be read to. When the answer was positive, the Reader would commonly spend 30 – 40 min reading and/or talking to the patient; between two and three patients, individually, were read to each day by each volunteer.
“We averaged 20–40 patients being read-to or talked-with weekly at the height of the program.” Books used included the Bible (Old and New Testaments), the Koran, a local newspaper or one of several novels (e.g., To Kill a Mockingbird or Sherlock Holmes detective novels). Some of the intubated and mechanically ventilated patients longed for more interaction, so notes were written on whiteboards or paper, and passed between the patient and Reader. Some patients desired only companionship”, noted Dr. Layon.
The ICU Reader Program was a controlled, non-randomized pilot study. The presence of a signal showing reduction of total delirium days in the cohort, as well as delirium days per patient, suggests that reading to, and/or talking with, patients in the ICU may be an effective, simple and low-cost intervention. As a service project and a research pilot, the ICU Reader Program was well-designed and successfully implemented; further randomized, controlled, and multi-centered studies are needed to ensure the validity of the findings.
An ICU Reader Program appears to decrease risk for, and duration of, delirium in adult ICU patients. Whether this effect is related to the reading itself or simple companionship, as well as the impact of comorbidities, age, gender and medications, is unclear.
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