Delirium in the Emergency Department: Novel Screening and Natural Course

急诊科的谵妄：新颖的筛选和自然过程

• 批准号: 8073128
• 负责人: Jin Ho Han
• 金额: $ 14.9万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8073128
• 关键词: Accident and Emergency department; Acute; Address; Admission activity; Adopted; Affect; Age Factors; Aging; Altered Level of Consciousness; American; Award; Biometry; Caring; Cessation of life; Clinical; Clinical effectiveness; Cognitive; Commit; Communities; Comorbidity; Confusion; Consult; Data; Death Rate; Delirium; Detection; Diagnostic; Early Diagnosis; Early treatment; Elderly; Emergency Care; Emergency Medicine; Emergency Situation; Enrollment; Environment; Epidemiology; Etiology; Foundations; Frequencies; Functional disorder; Funding; Future; Geriatric Nursing; Geriatrics; Goals; Healthcare; Healthcare Systems; High Prevalence; Home environment; Hospitalization; Hospitals; Impaired cognition; Inpatients; Institutes; Intensive Care Units; Intervention; Investigation; Learning; Letters; Medical; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Monitor; Mortality Decline; Needs Assessment; Neurosciences; Nurses; Nursing Research; Organ; Outcome; Patients; Pharmaceutical Preparations; Physicians; Pilot Projects; Population; Process; Psychiatrist; Psychiatry; Qualifying; Quality of Care; Quality of life; Random Allocation; Reference Standards; Research; Research Personnel; Research Proposals; Screening procedure; Sensitivity and Specificity; Series; Services; Severity of illness; Societies; Study Section; System; Testing; Thinking; Time; Training; Training Programs; Triage; Validation; Visit; Work; adverse outcome; aging population; base; career; career development; clinical practice; clinically significant; cost; design; follow-up; functional decline; functional status; human old age (65+); improved; inattention; indexing; insight; instrument; mental state; mortality; multidisciplinary; novel; novel strategies; older patient; programs; public health relevance; research and development

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.

描述（由申请人提供）：国家老龄化研究所K23奖将让韩博士成为老年急诊医学领域的独立研究者，并帮助他建立致力于改善老龄人口急诊护理的研究生涯。他将重点关注谵妄，因为谵妄影响着 10% 的老年急诊科 (ED) 患者，特别是因为这种形式的器官功能障碍是老年患者生活质量的主要威胁。该候选人的初步研究表明，急诊医生漏诊了 76% 的谵妄病例，这是一个严重的护理质量问题。然而，改善急诊科的谵妄检测存在重大障碍。首先，没有有效的谵妄评估可以在繁忙且要求严格的急诊室环境中进行。其次，急诊科中谵妄的临床意义仍不清楚，必须明确这一点，以便急诊医学界接受常规监测作为急诊科标准实践的一部分。为了克服这些障碍，Han 博士提出了一系列研究，这些研究将 1) 为急诊室开发一种新型谵妄监测，最大限度地提高效率并最大限度地减少急诊室工作人员的负担，2) 研究急诊科谵妄持续住院的频率，并确定其持续时间如何影响 6 个月死亡率和功能衰退。 急诊室是医疗保健系统的门户，每年照顾超过 1500 万老年患者。然而，急诊医生的装备很差，无法照顾这个快速增长的人口。因此，将研究工作集中在急诊室对于提高老年患者的护理质量至关重要。由于联邦资助的致力于老龄化研究的急诊室调查人员严重短缺，此类调查受到阻碍。韩博士将参加专门针对他的需求量身定制的职业发展培训计划。他将学习高级流行病学和生物统计学以及神经科学的课程。他亦会花时间到老年科及精神科住院咨询服务处学习如何评估急症长者的精神状态。韩博士的培训将由多学科高技能且合格的导师小组监督。通过利用该计划与机构优势，他准备改变急诊医生检测和治疗老年谵妄患者的方式。韩博士未来的目标是根据该提案中积累的数据开发基于 ED 的谵妄干预措施。这些干预措施将强调急诊科谵妄的早期诊断和治疗，并可能对急诊科护理老年人的方式产生深远的影响。 公共卫生相关性：谵妄是一种器官功能障碍，其特征是精神状态急剧变化、注意力不集中、思维混乱或意识水平改变。尽管谵妄与多种负面的患者结果相关，但医生漏诊谵妄的比率却高得惊人。因此，候选人将开发专门针对具有挑战性的 ED 环境的谵妄监测系统，并确定其临床意义，以便证明对谵妄的常规 ED 筛查是合理的。