Delirium in the Emergency Department: Novel Screening and Natural Course

描述(申请人提供)：国家老龄研究所K23奖项将使韩博士在老年急救医学领域发展成为一名独立的研究员，并帮助他建立致力于改善老龄化人口急救护理的研究生涯。他将专注于精神错乱，因为它影响到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对老年患者生活质量的主要威胁。候选人的初步研究表明，76%的病例被急诊医生遗漏，这是一个严重的护理质量问题。然而，在ED中，提高精神错乱的检测能力有很大的障碍。首先，在繁忙和要求苛刻的ED环境中，没有有效的精神错乱评估是可行的。其次，精神错乱在急诊科的临床意义尚不清楚，必须确定，以便急诊医学界接受常规监测，作为标准急诊科实践的一部分。为了克服这些障碍，韩博士提出了一系列研究，将1)为急诊室开发一种新的精神错乱监测，最大限度地提高效率，最大限度地减少急诊室工作人员的负担；2)研究急诊室精神错乱持续住院的频率，并确定其持续时间如何影响6个月的死亡率和功能衰退。急症室是医疗系统的大门，每年为超过1,500万名年老病人提供服务。然而，急诊医生在照顾这一快速增长的人口方面装备不足。因此，集中研究急诊室对于改善老年患者的护理质量至关重要。这种调查因联邦政府资助的致力于老龄化研究的ED调查人员严重短缺而受到阻碍。韩博士将参加专门为他的需求量身定做的职业发展培训计划。他将学习高级流行病学、生物统计学和神经科学方面的课程。他亦会与老人科及精神科住院诊症服务接触，学习如何评估病情危重的长者的精神状况。韩博士的培训将由一个由高技能和合格的导师组成的多学科小组监督。通过利用这一具有机构优势的计划，他准备改变急诊医生发现和治疗老年精神错乱患者的方式。韩博士未来的目标是在这项提案的基础上开发基于ED的精神错乱干预措施。这些干预措施将强调对急诊室精神错乱的早期诊断和治疗，并可能对急诊室照顾老年人的方式产生深远影响。

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.