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Background Delirium after acute stroke is a serious complication. Numerous studies support a benefit of multicomponent interventions in minimizing delirium-related complications in at-risk patients, but this has not been reported in acute stroke patients. The purpose of this study was to explore the feasibility of conducting a randomized (delirium care) versus usual standardized stroke care (usual care) in reducing delirium in acute stroke. Objective This pilot study assessed the feasibility of (1) enrollment within the 48-hour window when delirium risk is greatest, (2) measuring cognitive function using the Montreal Cognitive Assessment, (3) delivering interventions 7 days per week, and (4) determining delirium incidence in stroke-related cognitive dysfunction. Methods A 2-group randomized controlled trial was conducted. Patients admitted with ischemic and hemorrhagic strokes and 50 years or older, English speaking, and without delirium on admit were recruited, consented, and randomized to usual care or delirium care groups. Results Data from 125 subjects (delirium care, n = 59; usual care, n = 66) were analyzed. All Montreal Cognitive Assessment subscales were completed by 86% of subjects (delirium care, mean [SD], 18.14 [6.03]; usual care, mean [SD], 17.61 [6.29]). Subjects in the delirium care group received a mean of 6.10 therapeutic activities (range, 2-23) and daily medication review by a clinical pharmacist using anticholinergic drug calculations. Delirium incidence was 8% (10/125), 3 in the delirium care group and 7 in the usual care group. Conclusion Findings support the feasibility of delivering a multicomponent delirium prevention intervention in acute stroke and warrants testing intervention effects on delirium outcomes and anticholinergic medication administration.

Delirium in acute stroke has higher morbidity and mortality than those without delirium. This two-group randomized controlled trial (RCT) tests if a multicomponent intervention improves delirium outcomes in stroke patients at a comprehensive stroke center. This presentation describes the challenges in managing a RCT in acute stroke. Scientific rigor requires coordinating staff, enrolling adequate sample size, assuring intervention fidelity, and fostering data integrity. A sample of 282 subjects is required for 80% power (α=0.05) to determine a 10% reduction in incident delirium. Eligibility includes acute stroke, aged ≥ 50 years, no aphasia or delirium on admit. Subjects randomized to Usual Care (UC) or Delirium Care (DC). Both groups receive standardized Stroke Care. DC subjects receive a multicomponent intervention: 1) pharmacist recommendations using Anticholinergic Drug scale scores; and 2) therapeutic activities. NIHSS, Montreal Cognitive Assessment (MoCA), Confusion Assessment Method (CAM), and mRS are used to determine primary (delirium) and secondary endpoints (LOS, neurological deficit, functional status). A total of 513 patients screened over 289 consecutive days required unbudgeted staff. The 310 excluded [aphasia (94), baseline delirium (36), critically ill (92), LOS

Background: Stroke care involves a costly and time-sensitive interdisciplinary approach, which requires a supportive platform in order to explore novel patient care strategies. Our initiative aims to reduce costs and poor outcomes for stroke patients through increased coordination across the continuum of care. Methods: This innovative care model includes an inpatient component, Stroke Central. Stroke Central utilizes an intra-professional team of specialists, including vascular neurologists, advance practice nurses, and a registered nurse (RN) coordinator who serves as the central contact to handle all stroke-related concerns from staff and patients. The goal of Stroke Central is to provide comprehensive monitoring of patients throughout care, resulting in early detection and intervention in any complications. The role of the RN coordinator is vital as a facilitator for Stroke Central communication, care monitoring, and ongoing education and training among patients and healthcare professionals. The RN coordinator is charged with improving compliance with standard of care guidelines throughout the continuum of care and collaborating with other team members to monitor patients both remotely and directly. Results: After initiation of Stroke Central, results show improved patient outcomes for the 434 patients seen in the first two quarters of 2013 compared with the 822 patients seen in 2012. Lengths of stay indices have decreased in cases of hemorrhagic stroke (10%), ischemic stroke (19%) and transient ischemic attacks (31%). Complication and mortality rates in hospitals have also decreased; expected complication rate index for ischemic stroke decreased 10%, while the risk adjusted mortality index for ischemic stroke decreased 40%. Initial cost analyses indicate decreased costs for the inpatient component. Conclusion: Having a dedicated staff member, as a first and continual facilitator for contact has been essential in this innovative model. Incorporating this key role into primary stroke care can lead to an overall improvement in stroke outcomes in diverse hospital settings.