Implementation of the REDUCE Delirium with Eat Walk Engage program in Southern Adelaide Local Health Network: feasibility, acceptability and modelled economic analysis

Delirium is a common and preventable hospital acquired complication, causing distress for patients and staff, and is associated with longer hospital stays and the need for sub-acute and new nursing home care. It is the most common complication in older hospitalised adults in Australia. Eat Walk Engage® (EWE) is an evidence-based multidisciplinary program developed in Queensland to improve nutrition/hydration, mobility, and cognitive participation for older adults, and which reduces the incidence of delirium by 47%. EWE was implemented from February 2020 to June 2021 in an acute medical ward in South Australia. Structured observational data and patient and staff interviews were used to evaluate the feasibility and acceptability of implementation of EWE. An economic analysis was also undertaken to describe relevant patient pathways and the expected effects of the intervention. The model was populated using administrative patient data and published estimates of the EWE program including delirium and discharge to residential aged care. Observational data and patient experience interviews showed improvements in process indicators, indicating it was feasible to implement the program on the acute medical ward. Twenty-one staff interviews identified positive impacts on staff and ward culture, indicating acceptability of the program. EWE was feasible and acceptable in South Australia. The modelled economic analysis estimated that implementation of EWE is expected to save 73 occupied bed days per month in one acute medical ward. Based on the modelled economic evaluation, a 5:1 return on investment was calculated.