Delirium in the Emergency Department: Novel Screening and Natural Course

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DESCRIPTION (provided by applicant): The National Institute of Aging K23 award will allow Dr. Han to develop as an independent investigator in the field of geriatric emergency medicine, and help him establish a research career devoted to the improvement of emergency care in the aging population. He will focus on delirium since it affects 10% of elderly emergency department (ED) patients, especially because this form of organ dysfunction is a major threat to the older patient's quality of life. The candidate's preliminary studies suggest that delirium is missed in 76% of the cases by emergency physicians and is a serious quality of care issue. However, there are significant barriers to improving delirium detection in the ED. First, there are no valid delirium assessments that are feasible to perform in the busy and demanding ED environment. Second, the clinical significance of delirium in the ED remains unknown and must be established in order for the emergency medicine community to accept routine surveillance as a part of standard ED practice. To overcome these obstacles, Dr. Han proposes a series of studies that will 1) develop a novel delirium surveillance for the ED which maximizes efficiency and minimizes ED staff burden, and 2) study how often ED delirium persists into hospitalization and determine how its duration affects 6-month mortality and functional decline. The ED is the gateway of the health care system and cares for over 15 million elderly patients per year. Yet emergency physicians are poorly equipped to take care of this rapidly growing population. Thus, focusing research efforts on the ED is vital to improving the quality of care delivered to the older patient. Such investigations are hampered by the severe shortage of federally funded ED investigators committed to aging research. Dr. Han will participate in a career development training program specifically tailored for his needs. He will take coursework in advanced epidemiology and biostatistics, and neuroscience. He will also spend time with the geriatrics and psychiatric inpatient consult service to learn how to assess the mental status of acutely ill elders. Dr. Han's training will be overseen by a multidisciplinary group of highly skilled and qualified mentors. By leveraging this plan with institutional strengths, he is poised to alter the way emergency physicians detect and treat elderly patients with delirium. Dr. Han's future goal is to develop ED-based delirium interventions based upon the data accrued from this proposal. These interventions will emphasize early diagnosis and treatment of delirium in the ED, and will potentially have a profound impact in the way ED cares for older adults. PUBLIC HEALTH RELEVANCE: Delirium is a form of organ dysfunction that is characterized by an acute change in mental status, inattention, and either disorganized thinking or an altered level of consciousness. Although delirium is associated with a wide range of negative patient outcomes, physicians miss delirium at an alarmingly high rate. The candidate will therefore develop a delirium surveillance system specifically tailored for the challenging ED environment and establish its clinical significance so that routine ED screening of delirium can be justified.