Study uses design features of the ICU to evaluate delirium

(Boston)—Delirium is characterized by an acute change in cognition, accompanied by either altered consciousness or disorganized thinking. The condition is common in the post-surgical intensive care unit (ICU) setting, affecting up to 50-70% of those admitted, depending on individual risk profiles.

ICU delirium can be associated with a multitude of factors including underlying and acute medical conditions, pharmacologic agents or treatment regimens like surgery. Currently there is no definitive consensus on drug interventions that aid in the prevention of delirium or its treatment.

While there has been some evidence that the ICU environment plays a role in delirium, more research is needed to understand this association. In a new study from Mass General Brigham and collaborators at Boston University Chobanian & Avedisian School of Medicine, researchers found windowed patient rooms were associated with an increase in the odds of developing delirium, when compared to patient rooms without windows.

Using electronic medical records, the researchers reviewed the association between patients being admitted to an ICU room with or without windows and the presence of delirium. Delirium was observed in 21% (460/2,235) of patients in windowed rooms and 16% (206/1,292) of patients in non-windowed rooms.

“While the findings of the study were ultimately unexpected due to prior research suggesting the importance of circadian rhythm while in the hospital, our results contribute to a growing body of evidence-based design literature around the importance of healthcare design to patient experience and outcomes,” explained corresponding author Diana Anderson, MD, FACHA, assistant professor of neurology at the school. She notes that because of the study design, these unexpected findings are not causative and may represent different patterns in which some patients—who are potentially at an increased risk of delirium—may be assigned to different room layouts by the clinical teams.

According to the authors, further research into the specific qualities of windows that may impact health is needed to better understand these results. “Although this study adds to our understanding of the relationship between delirium and characteristics of the built environment, it is clear that additional studies may provide further insight to understand these results. For example, it is possible that the window view toward adjacent landscapes or buildings may be important context to interpret these findings, or perhaps another feature of the room such as light or sound that we could consider in our next investigation,” Anderson says.

These findings appear online in the journal Critical Care Medicine.

This work was supported by an internal Mass General Brigham Chief Academic Officer Pilot Grant. In addition, dedicated research time for Dr. Anderson was supported by Jacobs Architecture and Engineering.