Volunteers help keep delirium at bay in the emergency department

Volunteers have been a valued part of Sunnybrook Health Sciences Centre’s busy Emergency Department (ED) for many years. Almost 50 individuals volunteer in the ED on a regular basis, directing patients and providing comfort. However, in recent years these Volunteers have become even more integral as part of the Interprofessional Prevention of Delirium (IPPOD) team.
The IPPOD team has been in place in the Sunnybrook ED since 2007 under the direction of Dr. Jacques Lee and is helping to prevent delirium in older patients who are waiting for longer periods of time. Research shows that delirium often prolongs a hospital stay for the elderly by as much as 56 days. Monitoring patients susceptible to delirium is a simple, humanistic approach that can have a major impact on patient outcomes and length of stay.

“When an older person waits a long time, his or her risk of developing delirium doubles – which in some cases can be life-threatening,” says Dr. Lee. “ Older patients can become delirious because they’ve been waiting too long to be admitted or simply because we’ve taken their hearing aids or glasses away. Dehydration also plays a big factor, as does malnutrition.”

“I was approached by Dr. Lee two years ago about expanding the duties of the Volunteers in the ED,” says Beth Singleton, Volunteer Resources. “He explained that the ED Volunteers would work collaboratively and cooperatively with other ED staff. Since the program was implemented, all staff, from nurses to physicians to managers, have been committed to this program.”

On each shift, ED Volunteers get a list of elderly patients who have been in the ED for longer than eight hours.  Volunteers then talk with ED staff (nurse or physician) to find out if they may visit and about appropriate interventions for this patient (socialization, hydration, nutrition or mobilization activities.) If staff say it is okay, and the patient agrees, volunteers can get food, drink, and walk with patients. This information gets recorded so subsequent shifts of volunteers can see which patients were visited.

ED Volunteer, Chris Hails explains, “I like to engage them in as much conversation as they want, (without overstaying my welcome!) and make sure they are hydrated, if allowed to drink, as well as having enough to eat. I try to stress the importance of as much movement or walking as possible if they are ambulatory, or at least to try to sit up for a short period of time, for those who are able. Then other things, such as bringing reading/writing materials, if they are interested, and warm blankets etc.”

“Our ED Volunteers enjoy interacting with patients – that is why they choose to volunteer at a hospital for the most part,” says Ms. Singleton. “So being involved in the IPPOD program is rewarding and beneficial for all.”

“I have had a number of occasions where a patient has recognized me from a previous visit to the emergency department, and they always seem pleased to see a familiar face,” says Mr. Hails. “They seem a little more relaxed to know that I will be there to give them as much help as possible during my shift time, and I feel that sometimes it gives the patient a little more to focus on beyond their current situation.”