Delirium in the Emergency Department: Novel Screening and Natural Course

描述（由申请人提供）：国家老龄研究所K23奖将允许韩博士发展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年人口急诊护理的研究生涯。他将重点关注谵妄，因为它影响了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。候选人的初步研究表明，谵妄在76%的病例中被急诊医生遗漏，这是一个严重的护理质量问题。然而，在急诊科中改善谵妄检测存在重大障碍。首先，在繁忙和苛刻的急诊科环境中，没有有效的谵妄评估。其次，谵妄在急诊科的临床意义尚不清楚，必须加以确定，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的研究：1)为急诊科开发一种新的谵妄监测方法，最大限度地提高效率，最大限度地减少急诊科工作人员的负担；2)研究急诊科谵妄持续到住院的频率，并确定其持续时间如何影响6个月的死亡率和功能下降。急诊科是医疗保健系统的门户，每年照顾超过1500万老年患者。然而，急诊医生的装备不足，无法照顾这一迅速增长的人口。因此，将研究重点放在急诊科对提高老年患者的护理质量至关重要。由于联邦政府资助的致力于老龄研究的ED研究人员严重短缺，此类调查受到了阻碍。韩博士将参加一个专门为他量身定制的职业发展培训项目。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。他还将花时间与老年病学和精神病学住院咨询服务，学习如何评估急性疾病老年人的精神状态。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。通过利用这一计划与机构的优势，他准备改变急诊医生发现和治疗老年谵妄患者的方式。韩博士未来的目标是基于该提案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在急诊科早期诊断和治疗谵妄，并可能对急诊科照顾老年人的方式产生深远的影响。

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. 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.