Using the EMR to identify and screen patients at risk for delirium

Weckmann, Michelle

Abstract

This proposal is in response to Special Emphasis Notice (NOT-HS-13-006). The proposed research uses delirium recognition and screening to addresses AHRQ goals of implementing Stage 3 Meaningful Use Metrics, specifically, metrics related to identification of medical problems in real-time and improving accuracy of the problem list. Delirium is a medical condition which commonly occurs when a person is ill. When a person has delirium they are unable to think clearly and may be confused;in addition, delirium is commonly associated with rapid, intense mood changes, agitation, and hallucinations. Delirium is upsetting to the patient and everyone involved in his her care. Delirium is associated with many negative outcomes, some of which include: increased rates of nursing home placement, increased likelihood of developing dementia, increased hospital length of stay and costs and an increased risk of death. The goal of this proposal is to use Health Information Technology (Health IT) and the electronic medical record (EMR) to improve delirium screening, prevention, recognition and treatment in hospitalized patients which will subsequently lead to improved healthcare outcomes for patients/families and healthcare systems. Health IT has been used to improve the care of patients with other medical conditions (e.g. pneumonia) but has only be used in a very limited fashion with delirium. The overall objective of this project is to use Healthcare IT to implement a standardized delirium screening program in hospitalized patients at high risk for delirium. This will be accomplished by using the EMR to identify delirium risk factors, in hospitalized patients who are older than 64 years, and develop a delirium prediction rule. Once the prediction rule is created, the EMR will be used to identify patients at risk for delirium in real-time and the EMR will be used to prompt clinicians to document delirium in the problem list when a patient has a positive delirium screen. Attainment of the objectives will result in the development of an EMR-facilitated screening program which will improve delirium recognition leading to a decrease in healthcare costs and improvement in patient/family satisfaction. It is expected that the identification of patients at high risk for developing delirim at the point of care will allow for the design and implementation of clinical decision and support tools for both delirium prevention and treatment. More immediately, it is expected that the EMR based trigger for delirium screening will be disseminated across the hospitals that are part of our newly formed Accountable Care Organization (ACO);additionally, the model is expected to be directly transferable to other institutions using EPIC and should be adaptable to other healthcare systems in Iowa and across the country.

Public Health Relevance

Delirium is a major public health issue for the elderly, as well as, the healthcare system. Delirium results in significant morbidity for patients and families and increases medical costs on an already stressed healthcare system. The EMR is the perfect tool to identify and screen hospitalized older adults at risk for delirium in real- time leading to improved recognition and treatment of this challenging medical condition.