“I’m interested in chipping away at the question of whether discharging delirious people to their homes is the right thing to do or not.” –Adrian Austin, MD, MCSR
Adrian Austin is a pulmonary critical care physician, geriatrician, and delirium researcher at the University of North Carolina-Chapel Hill. He leads the UNC working group of investigators (“I-DUNC”) for better delirium assessment and education. Dr. Austin has two delirium-related pilot studies underway: a tablet-based delirium assessment tool for home use and a pharmacogenomic study of dose and response variability among mechanically ventilated ICU patients.
Here’s a recent interview on the goals and potential impact of this critical research. Part 1 in this series focuses on Dr. Austin’s tablet-based tool for post-acute home-based delirium assessment and followup.
How did you get started as a delirium researcher?
I came to UNC to do my internal medicine residency with the intention to do pulmonary critical care afterwards. I stacked my residency with a lot of critical care time, and also, I had a lot of geriatrics time. The majority of patients on both those services were delirious, and it complicated the management of just about everything. So that got me thinking about what is going on with delirium and what we should be doing about it. Back then, people didn’t call it delirium. Patients were just ‘confused.’ … Well, why is everybody confused?
During my residency, (Division of Geriatric Medicine Chief) Jan Busby-Whitehead talked me into spending a year with her in geriatrics where I got more formally exposed to delirium, and that’s when I started thinking about the issue as a research approach.
Also, on a personal note, when I was in medical school my grandfather had a cardiac bypass that went awry, and he was very confused for weeks after that and never really got back to being himself.
Pilot study on a tablet-based tool to enable delirium research in the post-acute home setting
One of my two pilot studies involves development of a video- and tablet-based delirium assessment tool. The HIPAA-compliant videoconferencing software is based on the CAM and can be used by families and caregivers in a home setting.
Initially, in the post-operative period, we observed that people who were delirious were being sent home. Which leads to the question, is that the right thing to do or not? My perception is that 20 years ago people were more frequently discharged to nursing homes while they were delirious. But current care models (and insurance drivers) are to get people home, which lends itself to a new research environment. My goal is to use the tablet to evaluate the effects of patients who are discharged while delirious.
It may be that returning delirious patients to their home environment is appropriate, or it may be that returning them home while confused, with new wounds and new opiate prescriptions, isn’t a great thing. But we don’t know. I’d like to answer that question.
Currently, to learn more we’d have to send somebody to the patient’s home, which is just too costly. My hope is that this remote tool will provide a financially feasible way to assess for delirium in the home and allow us to conduct ongoing future research in this environment.
What do you see this research leading to?
I’m developing a tool that researchers can use to look at delirium-related outcomes of various post-acute populations: post surgical, post ICU, post geriatric admission patients, and also patients transitioning from nursing centers to home. There are numerous research questions that can be explored if you have a tool to assess people in their home. I’m interested in chipping away at the question of whether discharging delirious people to their homes is the right thing to do or not. There’s clinical equipoise on that. I don’t know, personally, and sometimes I struggle with that question. Having some data to drive clinicians on that question, I think, would be immensely helpful for multiple specialties.
Check back in January for the second part of Dr. Austin’s interview where he discusses a pharmacogenomic study of dose and response variability among mechanically ventilated ICU patients.
For more information on delirium research, see the Network for the Investigation of Delirium: Unifying Scientists (NIDUS) website.