Implementation of delirium screening in the emergency department: A qualitative study with early adopters.
Introduction: Delirium affects 15% of older adults presenting to emergency departments (EDs) but is detected in only one‐third of cases. Evidence‐based guidelines for ED delirium screening exist, but are underutilized. Frontline staff perceptions about delirium and time and resource constraints are...
| Published in: | Journal of the American Geriatrics Society Vol. 72; no. 12; pp. 3753 - 3763 |
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| Main Authors: | , , , , , , , , , |
| Format: | Article |
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Wiley-Blackwell
Dec2024
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| Subjects: | |
| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=181624037&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 181624037 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00028614 20Q jtl: Journal of the American Geriatrics Society issn: 00028614 maglogo: Y pubinfo: dt: Dec2024 vid: 72 iid: 12 pid: 480 pub: Wiley-Blackwell artinfo: ui: 181624037 10.1111/jgs.19188 ppf: 3753 ppct: 10 formats: tig: atl: Implementation of delirium screening in the emergency department: A qualitative study with early adopters. aug: au: Chary, Anita N. Bhananker, Annika R. Brickhouse, Elise Torres, Beatrice Santangelo, Ilianna Godwin, Kyler M. Naik, Aanand D. Carpenter, Christopher R. Liu, Shan W. Kennedy, Maura affil: Department of Emergency Medicine, Baylor College of Medicine, Houston Texas,, USA Department of Medicine, Baylor College of Medicine, Houston Texas,, USA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston Texas,, USA School of Medicine, Baylor College of Medicine, Houston Texas,, USA University of Texas School of Public Health, UT Health Science Center, Houston Texas,, USA Department of Emergency Medicine, Massachusetts General Hospital, Boston Massachusetts,, USA Institute on Aging, University of Texas Health Science Center, Houston Texas,, USA Department of Emergency Medicine, Mayo Medical Center, Rochester Minnesota,, USA Harvard Medical School, Boston Massachusetts,, USA su: Canada United States Work Nurses Qualitative research Interviewing Content analysis Sound recordings Allied health personnel Physicians Psychological tests Experiential learning Diagnosis of delirium Research funding Early medical intervention Systems development Questionnaires Hospital emergency services Research methodology Delirium Early diagnosis sug: subj: Work Nurses Qualitative research Interviewing Content analysis Sound recordings Allied health personnel Physicians Psychological tests Experiential learning Canada United States Offices of Physicians (except Mental Health Specialists) Offices of physicians Integrated Record Production/Distribution Sound recording merchant wholesalers Record Production Diagnosis of delirium Research funding Early medical intervention Systems development Questionnaires Hospital emergency services Research methodology Delirium Early diagnosis keyword: delirium emergency department implementation science qualitative screening delirium emergency department implementation science qualitative screening ab: Introduction: Delirium affects 15% of older adults presenting to emergency departments (EDs) but is detected in only one‐third of cases. Evidence‐based guidelines for ED delirium screening exist, but are underutilized. Frontline staff perceptions about delirium and time and resource constraints are known barriers to ED delirium screening uptake. Early adopters of ED delirium screening can offer valuable lessons about successful implementation. Methods: We conducted semi‐structured interviews with clinician‐administrators leading ED delirium screening initiatives from 20 EDs in the United States and Canada. Interviews focused on experiences of planning and implementing ED delirium screening. Interviews lasted 15 to 50 minutes and were digitally recorded and transcribed. To identify factors that commonly impacted implementation of ED delirium screening, we used constructs from the Consolidated Framework for Implementation Research (CFIR), an Implementation Science framework widely used to evaluate healthcare improvement initiatives. Results: Overall, notable facilitators of successful implementation were having institutional and ED leadership support and designated clinical champions to longitudinally engage and educate frontline staff. We found specific examples of factors affecting implementation drawn from the following seven CFIR constructs: (1) intervention complexity, (2) intervention adaptability, (3) external policies and incentives, (4) peer pressure from other institutions, (5) the implementation climate of the ED, (6) staff knowledge and beliefs, and (7) engaging deliverers of intervention, that is, frontline ED staff. Conclusion: Implementing ED delirium screening is complex and requires institutional resources as well as clinical champions to engage frontline staff in a sustained fashion. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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