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

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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.