User Story: Inpatient Care During COVID-19

Ordering Provider

Rebecca Boyle, PA-C, inpatient hospital medicine, Stanford Health Care

How did you hear about the informatics consult program?

I first learned of the consult service after seeing it featured in the Stanford Health Care MedPulse email newsletter in September [2021]

What is your primary area of interest?

I work on an adult hospital medicine team and am interested in any way we can improve the experiences and outcomes of patients admitted to our service.

What question did you ask the Atropos informatics consult service?

Based on the observations of my colleagues, we hypothesized that limiting access to family and caregivers might predispose patients to delirium, a condition in which patients develop disturbances in attention and cognition over a short period of time. The initial consult question asked whether there was an increase in the incidence of delirium in hospitalized patients correlating with the time periods of visitor policies instituted during COVID-19.

When individuals are ill and in unfamiliar environments, they are at risk of becoming disoriented or delirious. The familiar presence of family or a caregiver can be effective to help reorient and calm the patient. When patients are unable to speak for themselves, the family can also provide valuable historical context as to the medications and care a patient needs to function their best.

When patients remain confused and disoriented despite attempts to redirect their focus, options to help keep the patient and staff safe include a one-to-one sitter [Atropos note: a sitter is usually a nursing assistant or nurse; virtual sitters can manage up to roughly 10 patients at a time], giving a medication intended to calm agitation (a “chemical restraint”), or physically restraining the patient. The latter is avoided if at all possible to respect the patient's freedom of movement and access to their own body. One: one sitter can be helpful to keep patients safe during limited episodes of delirium, however, may not be enough to calm patients who are physically aggressive or large in size.

As episodes of delirium are not always directly captured in clinical documentation, with the help of the consult service, we refined the question by using the incidence of chemical restraints (antipsychotic medications used to help calm patients with severe agitation) as a proxy for episodes of delirium: “Was there a correlation between the incidence of chemical restraint use and the implementation of restrictive visitor policies during COVID-19?”

In your own words, please describe the Atropos informatics consult service

My experience has been positive. Prior to submitting the consult, I questioned whether I might be able to effectively engage with the service without a prior background in informatics. However, I found the team to be encouraging and responsive. The process was similar to that of placing a speciality consult in medicine in that the team serves as a resource available for procedural guidance in areas in which the consultant themselves may not necessarily have the expertise or regular practice.