Identifying Implementation Strategies for Emergency Department (ED) Delirium Screening in Older Adults

项目摘要/摘要 精神错乱，或急性脑衰竭，影响高达30%的急救老年人，而且 与功能和认知能力下降、死亡率增加以及每年数十亿美元的 医疗保健成本。然而，三分之二的急诊科(ED)病例没有发现精神错乱；我们和 其他人发现，少数ED(~14%-22%)会对老年人进行精神错乱筛查。ED环境， 特点是病人数量大、过度拥挤以及并行处理患有以下疾病的病人 不同的敏锐度，可能代表着实施诸如精神错乱等过程的具有挑战性的背景 放映。该提案使用实施科学框架来确定成功实施的战略 实施勃起功能障碍筛查。ED是评估老年人精神错乱的重要部位 成年人的护理轨迹，因为在急诊室早期识别精神错乱可能会改善预防和 治疗、下游健康结果和降低成本。 这项建议的具体目标是：(1)使用对临床医生领导急诊的定性访谈 全美范围内的精神错乱筛查倡议，以确定实施的障碍和促进者， 以及(2)在一个城市高容量教育中使用快速人种学评估来确定成功的策略 在常规急诊工作流程中实施精神错乱筛查。这些目标加在一起，将产生新的 在提供细粒度数据的同时，还提供了关于全国范围内ED精神错乱筛查方法的广泛数据 关于基层实施的问题。这一建议在实施科学的运用上具有独特性和创新性。 框架和人类学方法，非常适合于调查医疗保健提供过程 在复杂的环境中，例如EDS。此外，与其他ED精神错乱研究不同的是，这些研究侧重于验证 在筛查工具中，这项研究将提供关于成功的战略的迫切需要的信息 筛选实施。 总体而言，这项工作将有助于我们促进采用和成功实施的长期目标 在美国进行广泛的ED妄想症筛查。ED精神错乱的实用实施策略 这项工作产生的筛选将有助于改进我们的方法，以实现后续的混合有效性- 实施试验，这将是申请者查里博士未来职业发展奖的主题 国家老龄问题研究所。

PROJECT SUMMARY/ABSTRACT Delirium, or acute brain failure, affects up to 30% of older adults presenting to emergency care and is associated with functional and cognitive decline, increased mortality, and billions of dollars in annual healthcare costs. However, delirium is not detected in two-thirds of emergency department (ED) cases; we and others have found that a minority of EDs (~14-22%) screen older adults for delirium. The ED environment, characterized by high patient volumes, overcrowding, and parallel processing of patients with conditions of varying acuity, can represent a challenging context for implementation of processes such as delirium screening. This proposal uses an implementation science framework to identify strategies for successful implementation of ED delirium screening. The ED is an important site for evaluation of delirium in an older adult’s care trajectory, as early recognition of delirium in the ED may lead to improved prevention and treatment, downstream health outcomes, and reduced costs. The specific aims of this proposal are to: (1) use qualitative interviews with clinicians leading ED delirium screening initiatives across the United States to identify barriers to and facilitators of implementation, and (2) use rapid ethnographic assessment in one urban high-volume ED to identify strategies for successful implementation of delirium screening within routine ED workflows. Together, these aims will generate novel data about a breadth of approaches to ED delirium screening nationwide while also providing granular data about ground-level implementation. This proposal is unique and innovative in its use of implementation science frameworks and anthropological methods, which are well-suited to investigating healthcare delivery processes in complex settings such as EDs. Furthermore, unlike other ED delirium research, which focuses on validation of screening tools, this research will provide urgently needed information about strategies for successful screening implementation. Overall, this work will facilitate our long-term goal of promoting adoption and successful implementation of ED delirium screening broadly in the United States. Practical implementation strategies for ED delirium screening generated from this work will help refine our approach for a subsequent hybrid effectiveness- implementation trial, which will be the subject of the applicant Dr. Chary’s future career development award to the National Institute on Aging.