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DeliriumNCT06736951

Modifying the Inpatient Environment to Reduce Delirium in Older Adults

A study testing MMSH (Multi-Modal Sleep Hygiene) Bundle in people with Delirium and Sleep Hygiene, run by Farhaan S. Vahidy at 5 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The overall goal is to reduce the incidence and burden of delirium, as measured by the delirium burden index (DBI) among hospitalized older adults (≥70 years), by modifying the inpatient environment to decrease its sleep antagonism. Read more about this study

Who is it for?
Ages 70 years and older
Conditions the study is for
Delirium, Sleep Hygiene
What is being tested?
MMSH (Multi-Modal Sleep Hygiene) Bundle
Could I receive a placebo?
No, everyone receives an active treatment
How many people
10,890 participants
Where
5 sitesUnited States
Study dates
1 Jun 2024to 31 Mar 2029
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 70 years and older
  • All sexes
  • No healthy volunteers
  • Older adult

Who may be able to join

  • Non-critically ill patients (≥70 years)
  • All sexes
  • All races and ethnicities
  • Admitted to the pre-specified clinical units which are part of the study

Who cannot join

  • Patients with active alcohol or substance withdrawal.
  • Patients with acute psychiatric illness
  • Patients with initial admission to intensive care unit including requirement for mechanical ventilation.
  • Patients present on a unit at the time of unit randomization

Trial locations and contacts

5 sites in 1 country. Contact the study team or a site near you to ask about taking part.

5 sites in 1 country

United States5 sites, 5 recruiting
  • Houston Methodist Baytown Hospital

    Baytown, Texas, 77521

    Rejani Nair, BSN, 346-356-1496, rrnair@houstonmethodist.org

    Farhaan Vahidy, PhD

    Recruiting
  • Houston Methodist Hospital

    Houston, Texas, 77030

    Rejani Nair, BSN, 346-356-1496, rrnair@houstonmethodist.org

    Farhaan Vahidy, PhD

    Recruiting
  • Houston Methodist Research Institute

    Houston, Texas, 77030

    Rejani Nair, BSN, 346-356-1496, rrnair@houstonmethodist.org

    Farhaan Vahidy, PhD

    Recruiting
  • Houston Methodist West Hospital

    Houston, Texas, 77094

    Rejani Nair, BSN, 346-356-1496, rrnair@houstonmethodist.org

    Farhaan Vahidy, PhD

    Recruiting
  • Houston Methodist Sugarland Hospital

    Sugarland, Texas, 77479

    Rejani Nair, BSN, 346-356-1496, rrnair@houstonmethodist.org

    Farhaan Vahidy, PhD

    Recruiting

Other trials in United States

About this study

Official title: Modifying the Inpatient Environment to Reduce the Incidence and Burden of Delirium Among Hospitalized Older Adults (≥70 Years).

The overall goal is to reduce the incidence and burden of delirium, as measured by the delirium burden index (DBI) among hospitalized older adults (≥70 years), by modifying the inpatient environment to decrease its sleep antagonism. The investigators propose to implement a multi-modal sleep hygiene (MMSH) bundle, an enhancement of a previously reported sleep-focused intervention which had 88 - 100% compliance for intervention components, and reduced ICU delirium by 50%.

Read the detailed description

The Investigators will implement the MMSH in a randomized step-wedge cluster design across 11 independent nursing units of 4 Methodist hospitals. While primarily focusing on the MMSH effectiveness, the investigators will conduct process evaluation to identify barriers and facilitators for MMSH implementation.

Specific Aim 1: Establish the comparative effectiveness of an in-hospital, MMSH towards reducing the rate of incident (hospital acquired) delirium (HAD) among older adults (age ≥ 70). The investigators will compare the rate of incident delirium between patients receiving the MMSH bundle in addition to the Standard of Care delirium screening and prevention protocol (SOC-DSPP), and those who are managed only under the SOC-DSPP. The SOC-DSPP through out all HM units includes twice daily deliruim screening with the 4AI. Outcome: The primary outcome is incident delirium (or HAD), determined by a positive 4AT, among patients who did not have delirium present on admission. The investigators hypothesize a 33% reduction in incident delirium among patients receiving the MMSH bundle.

Specific Aim 2: Establish the comparative effectiveness of an in-hospital, MMSH towards reducing delirium burden, as measured by DBI, among older adults (age ≥ 70), either with HAD or with D-POA. The investigators will compare the DBI between patients receiving the MMSH bundle in addition to the SOC-DSPP with that of those who were managed only under the SOC-DSPP. Outcome: The primary outcome is patient-level DBI [(number of positive 4AT screens)2/total number of 4AT screens)]. The DBI will be a non-zero positive fraction which is scale free because it accounts for the duration of observation by taking into consideration the total number of delirium assessments. Investigators hypothesize a 25% reduction in DBI among patients receiving the MMSH bundle.

Specific Aim 3: Evaluate the barriers and facilitators of implementing a MMSH bundle across community and academic hospitals and assess compliance with various MMSH bundle components. Outcomes: The outcomes are the reasons and factors that either promote or hinder implementation of the MMSH bundle. The investigators will also measure proportional compliance with each MMSH bundle component across the entire period implementation for all clusters (units).

Exploratory Aim: Compare sleep quality, as monitored by actigraphy, between patients receiving the MMSH bundle in addition to the SOC-DSPP with that of those who were managed under the SOC-DSPP only. Outcome: The outcomes are sleep duration, and frequency of awakenings during the hours of 10:00 pm and 5:00 am (i.e., Z-time) ,day to day variability and circadian rest-activity rhythm.

Being tested
MMSH (Multi-Modal Sleep Hygiene) Bundle
Medical subject headings
Delirium, Sleep Hygiene

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MMSH (Multi-Modal Sleep Hygiene) BundleOther

    Focus on Noise Reduce Noise Perception, Reduce Hallway Noise, Reduce Noise in Rooms Focus on Light Reduce Lights at Night, Increase Light in Day, Reduce Light Perception Focus on Staff-Patient Interactions Delirium Screening, Avoid Care Procedures at Night, Z-time Plan \& Prep Focus on Daytime Activity Increased Mobility, Increase Patient Engagement Focus on Medications Pain Management, Medication Monitoring, Continue pharmacy protocols, Timing of Medications/Monitoring Labs

Study groups in NCT06736951
Study groupRoleWhat they receive
MMSH (Multi-Modal Sleep Hygiene) BundleExperimentalWe will implement an MMSH bundle, enhancing a previously reported sleep focused intervention, in order to increase quality/quantity of sleep during Z-time (i.e., 10pm to 5am) in our intervention units, subsequently mitigating the burden of delirium in hospitalized older adults. Our proposed intervention domains perfectly align with the expressed patient suggestions to improve patient experience. Sleep disruption issues were raised at similar rates across the age span suggesting our MMSH will positively impact patients of all ages, including those with lower risk of delirium. The intervention components are outlined below and a comparison to the current standard of care and the components that are relevant to the fidelity aspects of the study are highlighted in the table. The main focus of the sleep interventions will focus on Noise, Light, Staff-Patient Interactions, Daytime Activity and Medications.
Receives: Other: MMSH (Multi-Modal Sleep Hygiene) Bundle
Standard of CareNo interventionThis study arm reflects patients receiving standard of care treatment without any modification of in-hospital sleep environment

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence (cumulative or proportion) of hospital acquired delirium (HAD) among patients who did not have delirium present on admission (D-POA)

    Proportion of patients who develop HAD among those who did not have D-POA. D-POA is defined as 4AT positivity (at least one) during the first 48 hours of hospital admission. HAD is defined as 4AT positivity (at least one) after 48 hours of 4AT negatives.

    Measured: From the date of admission to the date of discharge or death, whichever comes first, outcome will be assessed at every 12 hours (twice in a 24 hour time period), up to 5 years

  2. Delirium Burden Index (DBI) among patients with either delirium present on admission or those who develop HAD

    Proportion of positive 4AT assessments (squared) among all 4AT assessments. Patient level metric of delirium burden. Scale free, non-zero number. [(#4AT+)2 / #Total 4AT]

    Measured: From the date of admission to the date of discharge or death, whichever comes first, outcome will be assessed at every 12 hours (twice in a 24 hour time period), up to 5 years

  3. Adherence to MMSH bundle components: Nighttime and Daytime

    Reported as frequency and proportion of patients among whom full implementation was possible. Frequency and proportion of adherence with individual bundle components.

    Measured: Starting from the date of randomization till the date of termination of the study assessments will be made twice weekly for each unit, up to 5 years

  4. Factors facilitating or impeding implementation of MMSH bundle

    Qualitative / thematic analysis of semi-structured focus groups with unit staff and PFAC stakeholders

    Measured: From the date of randomization assessments made up to 5 years

Secondary outcomes (14)
  1. Resolution of delirium present on admission (D-POA)

    Proportion of D-POA patients who resolve delirium. Defined as no positive 4AT screens following 48-hours of hospitalization among those who were positive during first 48 hours

    Measured: From the date of admission to the date of discharge or death, whichever comes first, outcome will be assessed at every 12 hours (twice in a 24 hour time period), up to 5 years

  2. Delirium Assessment Positivity Rate

    Patient level indicator for the proportion of positive 4AT screen to the total number of 4AT screens for both D-POA and HAD patients

    Measured: From the date of admission to the date of discharge or death, whichever comes first, outcome will be assessed at every 12 hours (twice in a 24 hour time period), up to 5 years

  3. Length of Hospital Stay (days)

    Median (interquartile range) for number of days of hospitalization, compared between intervention and SOC patients

    Measured: From the date of admission to the date of discharge or death, whichever comes first, up to 5 years

  4. Delirium free days

    Among patients with either incident delirium or delirium present on admission, the number of days (24 hours periods) which were free of delirium (all negative 4AT screens).

    Measured: From the date of admission to the date of discharge or death, whichever comes first, outcome will be assessed at every 12 hours (twice in a 24 hour time period), up to 5 years

  5. In hospital mortality

    Proportion of patients experiencing in hospital mortality for intervention vs the SOC groups

    Measured: Date of admission to the date of discharge or the date of death, which ever comes first, up to 5 years

  6. Hospital discharge disposition

    Favorable discharge disposition (home or rehab) vs. unfavorable disposition (SNF, LTAC, Nursing Home)

    Measured: Date of admission to the date of discharge (for patients discharged alive), up to 5 years

  7. In Hospital complications

    Pre-defined set of in-hospital complications (pneumonia, sepsis, UTI, DVT) will be tracked.

    Measured: Date of admission to the date of discharge or death, whichever comes first, up to 5 years

  8. Need for higher level of care

    Need for higher acuity care

    Measured: Date of admission to the date of discharge or death, which ever comes first, up to 5 years

  9. Duration of daytime sleeping via actigraphy (non Z-time sleeping)

    Analysis of actigraphy data. Non - Z time sleep duration

    Measured: Baseline to Year 5

  10. Patient Experience

    HCAHPS scores in patients aged 65 and older by unit preintervention versus post intervention. The question used will be: "During this hospital stay, how often was the area around your room quiet at night?"

    Measured: Baseline to Year 5

  11. Mobilization/Daytime Activity

    Mobility Dashboard data of Percentage of Patient Days per unit with Any Activity Documented in patients aged 70 or greater on the intervention unit

    Measured: Date of admission to the date of discharge or death (which ever comes first), up to 5 years

  12. Sleep Quality for Actigraphy Patients

    Daily sleep quality survey and post-discharge sleep quality survey

    Measured: From the date of enrollment to the date of discharge or death, which ever comes first, assessed daily (for the daily survey), and assessed once post-discharge (for the post-discharge survey), up to 5 years

  13. Sleep quality for all enrolled patients

    Alternate day sleep quality survey for all enrolled patients (excluding actigraphy patients)

    Measured: Date of admission to the date of discharge, or death, whichever comes first, assessed every other day, up to 5 years.

  14. Incidence rate of hospital acquired delirium (HAD) among patients who did not have delirium present on admission (DPOA)

    Number of new cases of delirium (among those who were non-D-POA) per person-time.

    Measured: From the date of admission to the date of discharge or death, whichever comes first, outcome will be assessed at every 12 hours (twice in a 24 hour time period), up to 5 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Dec 2024
  2. Study start1 Jun 2024
  3. Primary completion31 Mar 2029 (estimated)
  4. Study completion31 Mar 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Crossover
Model description
This is a step-wedge cluster randomized controlled trials in which hospital units will cross over from control to intervention phase in a randomly assigned sequence.
Masking
None (open label)
Enrolment
10,890 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06736951
Sponsor's protocol ID
PRO00037893
Status last verified
Dec 2024
First submitted
1 Sep 2024
Last updated
17 Dec 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: The plan to share IPD is undecided.

Publications

  • Patel J, Baldwin J, Bunting P, Laha S. The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia. 2014 Jun;69(6):540-9. doi: 10.1111/anae.12638.

    PubMed 24813132

Questions about this trial

What is this clinical trial studying?

A study testing MMSH (Multi-Modal Sleep Hygiene) Bundle in people with Delirium and Sleep Hygiene, run by Farhaan S. Vahidy at 5 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 17 Dec 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Rejani Nair, BSN (346-356-1496, rrnair@houstonmethodist.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence (cumulative or proportion) of hospital acquired delirium (HAD) among patients who did not have delirium present on admission (D-POA) (time frame: From the date of admission to the date of discharge or death, whichever comes first, outcome will be assessed at every 12 hours (twice in a 24 hour time period), up to 5 years). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06736951, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Dec 2024.

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