Harnessing the Power of Technology to Transform Delirium Severity Measurement in the ICU

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PROJECT SUMMARY/ABSTRACT This K23 application outlines a career development plan that will advance Dr. Heidi Lindroth on her pathway to becoming an extramurally funded, independent clinician-nurse scientist. Her long-term career goal is to become an international leader focused on mitigating delirium severity in older adults, reducing the risk and burden of adverse outcomes, including Alzheimer’s Disease and related Dementias (ADRD). Delirium, an acute and fluctuating disturbance in consciousness and cognition, impacts 70-80% of mechanically ventilated, intensive care unit (ICU) older adults. Severe delirium accelerates the rate of global cognitive decline leading to an increased risk of ADRD. Therefore, reducing delirium severity holds great promise in decreasing ADRD burden. Unfortunately, delirium severity is seldom monitored in the ICU. Accurate and timely measurement of delirium severity is urgently needed to implement the proper, evidence-based treatment at the right time. To begin to fill this significant gap in clinical care, Dr. Lindroth’s proposed research study will leverage the foundational work completed in the Mayo Clinic Herasevich Clinical Informatics Laboratory to develop and preliminary test a passive digital marker (PDM) for delirium severity in critically ill, older adults. Like a continuous vital sign, this PDM would provide immediate and actionable feedback to clinicians on the status of delirium severity in ICU patients. Older adult (>65 years old) patients who are anticipated to remain in the ICU for >24 hours will be prospectively recruited upon their admission to the medical ICU at Mayo Clinic, Rochester, MN, and the general ICU at the Mayo Clinic, Eau Claire, WI for both stages of the study (development-aims 1 and 2; pilot RCT-aim 3; total n=230) and followed until either death and/or discharge from the ICU. Data collected will include continuous digital video recordings of the patient in their ICU room, routine EHR data, and study team administered delirium severity assessments. The pilot RCT in Aim 3 will randomize participants (1:1, computer-generated assignment) to either the intervention (PDM for delirium severity) or usual care with the primary outcomes of usability and acceptability. Dr. Lindroth has co-designed a career development plan and a research proposal with her transdisciplinary mentorship team to accomplish the following short-term objectives to: 1) acquire informatics and data science knowledge to design/build tools that support clinical decision making; 2) gain experience in the conduct of prospective ICU clinical trials in older adults, and; 3) acquire and develop grant writing skills. These short-term objectives will be accomplished through formal training (Masters in Artificial Intelligence in Healthcare), experiential learning (conduct of proposed study), and focused mentorship Thus, this K23 award will allow Dr. Lindroth to progress in her career development plan and provide her with necessary protected time to acquire the outlined research skills, knowledge, and experience to continue her pathway towards independence.