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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

基本信息

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
项目类别：
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

项目摘要

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.

项目总结/摘要谵妄，或急性脑衰竭，影响多达30%的老年人提出的紧急护理，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医疗费用。然而，在三分之二的急诊科（艾德）病例中未检测到谵妄;我们和其他人发现少数ED（约14-22%）筛查老年人的谵妄。艾德环境，其特点是患者数量大，过度拥挤，并平行处理患者的条件，不同的敏锐度，可以代表一个具有挑战性的背景下实施的过程，如谵妄筛选该提案使用实施科学框架来确定成功实施的战略。实施艾德谵妄筛查。艾德是评估老年人谵妄的重要部位。成人的护理轨迹，因为在艾德中早期识别谵妄可能会导致预防和治疗、下游健康成果和降低成本。本建议的具体目标是：（1）使用定性访谈与临床医生领导艾德美国各地的谵妄筛查倡议，以确定实施的障碍和促进因素，和（2）在一个城市高容量艾德中使用快速人种志评估来确定成功的策略在常规艾德工作流程中实施谵妄筛查。总之，这些目标将产生新的关于全国范围内艾德谵妄筛查方法的广泛性的数据，同时还提供了粒度数据关于基层执行。这一建议是独特的和创新的，在其使用的实施科学框架和人类学方法，非常适合调查医疗保健提供过程在复杂的环境中，如ED。此外，与其他艾德谵妄研究不同，筛选工具，这项研究将提供迫切需要的信息，战略，成功地筛选实施。总的来说，这项工作将有助于我们实现促进采用和成功实施的长期目标艾德谵妄筛查在美国的广泛应用。艾德谵妄的实用实施策略从这项工作中产生的筛选将有助于改进我们的方法，以实现随后的混合效果- 实施试验，这将是申请人博士的主题。查里的未来职业发展奖，国家老龄化研究所。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

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。