The purpose of the study was to investigate the risk factors and symptoms of delirium, and the intervention provided to the inpatients with delirium based on the EMR(Electronic Medical Record) data in Korea. The data of 108 inpatients who had the diagnosis of delirium during their hospital stay from July to December in 2016 were collected from the EMR record at a tertiary university hospital in Daejeon.
The checklist was constructed to collect the data regarding the risk factors, symptoms, and interventions related to delirium. Data were analyzed by frequency, percentage, mean and standard deviation, and Chi-square test. The characteristics of risk factors, symptoms, and intervention related to the delirium were further compared according to the timing of the intervention (immediate vs. delayed) and type of the delirium (with or without aggressive behaviors).

The mean age of the patients who showed delirium during their hospital stay was 74.22 years old, ranged from 45 to 96 years. More men (n=70, 64.8%) were included than women (n=38, 35.2%). The patients were admitted to osthopedic surgery department (n=51, 47.2%) followed by infection medicine (n=12, 11.1%), and gastrointestinal medicine (n=11, 10.2%). Most patients (n=79, 73.1%) were admitted via emergency room. Their hospital stay was 39.66 days in average, ranged from a minimum of 3 days to the maximum of 529 days. About half of the patients showed delirium in 5 days (50%), and 13 patients (12.1%) showed delirium after 20 days of the admission. Seven patients (6.5%) had delirium in previous hospitalization.
In the comparison by the timing of intervention, the patients with immediate intervention had significantly more risk factors of unbalanced nutrition(χ2=4.898, p=.027), and pain(χ2=6.559, p=.038), and more symptoms of change of sleep pattern(χ2=4.031, p=.045), declined cognitive function(χ2=4.898, p=.027), behavior disorder(χ2=7.598, p=.006), confusion(χ2=5.803, p=.016), and thought disorder(χ2=8.760, p=.003). The patients with immediate intervention were provided more intervention of orientation training(χ2=4.398, p=.036), limited physical activity(χ2=11.048, p=.001), behavioral problem management(χ2=7.790, p=.005), emotional support(χ2=4.945, p=.026), and aggressive behavior management(χ2=17.241, p<.001), and monitoring medication effect(χ2=6.502, p=.011).
In the comparison by aggressive behavior, those with aggressive behavior showed more risk factor of the use of physical restraint(χ2=3.924, p=.048), and more symptoms of behavior disorder(χ2=33.990), p<.001), change in perception(χ2=4.499, p=.034), and language disorder(χ2=4.063, p=.044). The patients with aggressive behavior were provided more intervention of check vital sign(χ2=7.240, p=.007), infection management(χ2=5.684, p=.017), limited physical activity(χ2=18.963, p<.001), and behavioral problem management(χ2=26.709, p<.001).
In conclusion, delirium was prevalent in older patients who had orthopedic surgery with 5 days or longer hospital stay. The delirium related intervention was more likely given immediately when the patients showed aggressive behavior. The study findings should be interpreted with caution due to the retrospective data collection based on EMR record. Further studies are warranted to explore predictive factors of delirium with prospective design to confirm the effect of intervention. Additional research is required to determined the efficacy of restraint in nursing delirious patients with aggressive behavior.

Key words: Inpatient, Delirium, Risk factor, Symptom, Intervention