To review the management of Idiopathic Parkinson’s Disease (PD) in the inpatient setting and evaluate the need for systems-based intervention.
Management of PD while hospitalized is complex due to motor complications, falls, aspiration and encephalopathy. Prior studies have shown increased admission rates and lengths of stay in those with PD. Proposed causative factors include medication management errors, reduced mobilization, infections, and sub-optimal delirium prevention strategies. The aim of this study was to evaluate inpatient management of PD at Mayo Clinic Arizona (MCA) and determine whether systems-based interventions could improve patient outcomes.
A retrospective analysis was performed from 2020-2023 for all PD admissions. Atypical parkinsonism, drug-induced parkinsonism and new PD diagnoses were excluded. Primary outcome measure was need for inpatient neurology consultation. Secondary outcome measures were appropriate timing and dosage of medication on admission, initiation of fall and aspiration precautions, duration of stay, falls and encephalopathy.
163 patients were identified after exclusion criteria were applied. Patient demographic data was notable for mean age of 72.3 (8.2), average years since diagnosis was 8.8, 57% of patients had a Hoehn and Yahr Scale of IV or V. Average duration of hospital stay was 8.09 days. Neurology consultation was obtained for 92/163(48.5%) of patients with most consults being for medication management (65%) and encephalopathy (13%). Medication errors were noted in 108/163(66.25%) of encounters. Fall precautions were ordered for 90/163(55.3%) and 4 falls occurred in the study period. Aspiration precautions were ordered for 93/163(57%) and 10 documented clinical aspirations occurred. Encephalopathy occurred in 56/163(34.36%) with increased relative risk of 2.1 in those with medication errors.
Our study identifies that PD patients commonly experience acute worsening while inpatient. Initial interventions to reduce adverse events would include identifying PD patients upon admission and creating a workflow for PD medication review, ordering of fall, aspiration and delirium precautions.