Delirium is a common condition in older patients presenting to the ED, present in up to 20% of geriatric patients, and is associated with adverse clinical, cognitive and functional outcomes. Identification and documentation of delirium is associated with improved outcomes, yet delirium goes unrecognized and undocumented in the ED up to 80% of the time. The ED offers a unique setting to rapidly identify and begin managing delirious patients at the point of entry to the hospital, but the efficacy of systematic screening combined with guidelines for initial management in the ED has not been examined. We will refine and pilot test an intervention, Delirium Screening (D-SCREEN), involving 300 older patients (150 newly enrolled intervention participants, 150 historical controls (comparison group) currently being collected), that has 4 key components: 1. Systematic screening for delirium using the CAM, 2. Informing providers of the screening result, 3. Providing a checklist protocol for initial delirium management based on clinical guidelines, and 4. Documentation of the diagnosis of delirium in the Electronic Medical Record (EMR) and communication with inpatient providers.
The specific aims of the proposed project are to: 1. Refine and test the feasibility and acceptability of the D- SCREEN intervention using quantitative data from medical record review of intervention adherence and qualitative data collected through focus group interviews with ED providers (M.D.s and R.N.s) pre-and post intervention, and 2. Examine the impact of D-SCREEN on documentation of delirium in the 150 newly enrolled intervention group compared with 150 already collected historical controls. Our findings will provide state-of- the-art evaluation of an innovative yet pragmatic 4-step screening intervention for delirium in the ED that includes a checklist protocol for initial delirium management at point of hospital entry.

Public Health Relevance

Delirium is a common condition in patients in the Emergency Department (ED), impacting between 10-20% of elderly ED patients, that often goes unrecognized and is associated with adverse clinical outcomes. The ED offers a unique opportunity to identify and initiate early treatment of delirium to shorten the course, reduce complications and enhance patient outcomes. We will pilot test an intervention that combines systematic screening for delirium with informing ED clinicians of screening result and providing them with a checklist protocol of evidence-based delirium management techniques that are tailored to the ED setting. Documentation of delirium in the intervention group will be compared to a historical comparison group.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21AG049239-02
Application #
9145146
Study Section
Aging Systems and Geriatrics Study Section (ASG)
Program Officer
Wagster, Molly V
Project Start
2015-09-30
Project End
2017-05-31
Budget Start
2016-06-01
Budget End
2017-05-31
Support Year
2
Fiscal Year
2016
Total Cost
Indirect Cost
Name
University of Massachusetts Medical School Worcester
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
603847393
City
Worcester
State
MA
Country
United States
Zip Code