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

确定老年人急诊科 (ED) 谵妄筛查的实施策略

• 批准号: 10704121
• 负责人: ANITA CHARY
• 金额: $ 16万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704121
• 关键词: Accident and Emergency department; Accreditation; Acute; Admission activity; Adopted; Adoption; Affect; Anthropology; Award; Brain; Caring; Characteristics; Code; Complex; Consolidated Framework for Implementation Research; Crowding; Data; Data Set; Decision Making; Delirium; Detection; Development; Elderly; Emergency Care; Emergency Medicine; Emergency department crowding; Emergency department visit; Environment; Ethnography; Evaluation; Failure; Future; Geriatrics; Goals; Health; Health Care Costs; Hospitalization; Human; Human Resources; Immersion; Impaired cognition; Individual; Injury; Inpatients; Institution; Interview; K-Series Research Career Programs; Leadership; Maps; Mentorship; Methods; Minority; Mission; Morbidity - disease rate; Motivation; National Institute on Aging; Nurses; Outcome; Patient Care; Patients; Pattern; Physicians; Prevention; Prevention Protocols; Process; Public Health; Qualitative Methods; Research; Resources; Sampling; Screening procedure; Site; Syndrome; Techniques; Time; Training; Transcript; Treatment Protocols; United States; United States National Institutes of Health; Validation; Visit; Work; brain dysfunction; cost; diagnostic accuracy; effectiveness/implementation trial; emergency settings; evidence based guidelines; experience; functional decline; future implementation; health care delivery; implementation context; implementation facilitators; implementation framework; implementation science; implementation strategy; improved; innovation; insight; instrument; mortality; novel; parallel processing; participant observation; pragmatic implementation; routine care; screening; skills; treatment as usual

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.

项目概要/摘要 多达 30% 的老年人因出现谵妄或急性脑衰竭而接受紧急护理，并且 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损失有关 医疗费用。然而，三分之二的急诊室 (ED) 病例并未检测到谵妄；我们和 其他人发现少数急诊室 (~14-22%) 对老年人进行谵妄筛查。急诊室环境， 其特点是患者量大、过度拥挤以及对患有以下疾病的患者进行并行处理 不同的敏锐度，可以代表实施诸如谵妄之类的过程的具有挑战性的环境 筛选。该提案使用实施科学框架来确定成功的策略 实施 ED 谵妄筛查。急诊室是评估老年人谵妄的重要场所 成人的护理轨迹，因为在急诊室早期识别谵妄可能会改善预防和治疗 治疗、下游健康结果以及降低成本。 该提案的具体目标是：(1) 对领导 ED 的临床医生进行定性访谈 在美国各地开展谵妄筛查举措，以确定实施的障碍和促进因素， (2) 在一个城市大容量急诊室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谵妄筛查。这些目标共同将产生新颖的 有关全国范围内 ED 谵妄筛查方法的广泛数据，同时还提供详细数据 关于基层实施。该提案在实施科学的运用方面是独特且创新的 框架和人类学方法，非常适合调查医疗保健提供过程 在复杂的环境中，例如急诊室。此外，与其他 ED 谵妄研究不同的是，其他研究侧重于验证 筛选工具，这项研究将提供有关成功策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 美国广泛开展 ED 谵妄筛查。 ED 谵妄的实际实施策略 这项工作产生的筛选将有助于完善我们的方法，以实现后续的混合有效性- 实施试验，这将是申请人 Chary 博士未来职业发展奖的主题 国家老龄化研究所。

项目成果

Language discordance in emergency department delirium screening: Results from a qualitative interview-based study.

急诊科谵妄筛查中的语言不一致：基于定性访谈的研究结果。

• DOI: 10.1111/jgs.18147
• 发表时间: 2023
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Chary,AnitaN;Torres,Beatrice;Brickhouse,Elise;Santangelo,Ilianna;Godwin,KylerM;Naik,AanandD;Carpenter,ChristopherR;Liu,ShanW;Kennedy,Maura
• 通讯作者: Kennedy,Maura

Leveraging the Electronic Health Record to Implement Emergency Department Delirium Screening.

利用电子健康记录实施急诊科谵妄筛查。

• DOI: 10.1055/a-2073-3736
• 发表时间: 2023
• 期刊: Applied clinical informatics
• 影响因子: 2.9
• 作者: Chary,AnitaN;Brickhouse,Elise;Torres,Beatrice;Santangelo,Ilianna;Carpenter,ChristopherR;Liu,ShanW;Godwin,KylerM;Naik,AanandD;Singh,Hardeep;Kennedy,Maura
• 通讯作者: Kennedy,Maura

Reply to: Expanding options to include language barriers for predicting postoperative delirium in geriatric patients.

回复：扩大选择范围，将语言障碍纳入预测老年患者术后谵妄的范围。

• DOI: 10.1111/jgs.18083
• 发表时间: 2023
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Chary,AnitaN;Naik,AanandD;Kennedy,Maura
• 通讯作者: Kennedy,Maura