Improving Delirium Screening and Detection in the Emergency Department (ED): The Implementation and Evaluation of the ED Delirium Detection Program.
Background: Delirium is missed in over 75% of older adults presenting to the Emergency Department (ED). The study aimed to determine the efficacy of the ED Delirium Detection Program (ED‐DDP) to improve delirium detection while evaluating implementation outcomes. Methods: The ED‐DDP consisted of a t...
| Publicado en: | Academic Emergency Medicine Vol. 33; no. 2; pp. 1 - 12 |
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| Autores principales: | , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Wiley-Blackwell
Feb2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=191894082&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 191894082 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10696563 Z27 jtl: Academic Emergency Medicine issn: 10696563 maglogo: Y pubinfo: dt: Feb2026 vid: 33 iid: 2 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 191894082 191894082 191894082 10.1111/acem.70235 191894082 ppf: 1 ppct: 11 formats: tig: atl: Improving Delirium Screening and Detection in the Emergency Department (ED): The Implementation and Evaluation of the ED Delirium Detection Program. aug: au: Sinvani, Liron Perrin, Alexandra Huebschmann, Amy G. Basile, Melissa Groton, Stephanie Barnaby, Doug Sanchez, Gabriel Chiuzan, Codruta Chua, Vince Slotnick, Stefani Porreca, Kristen Romano, Krisia Kwiatek, Susan Cary, Karen Garg, Nidhi Sud, Payal Makhnevich, Alex affil: Northwell Health, New Hyde Park New York,, USA sug: subj: Emergency Service Delirium Diagnosis Health Screening Program Implementation Program Evaluation Quality Improvement Delirium Prevention and Control Human Funding Source New York Male Female Aged Aged, 80 and Over Randomized Controlled Trials Random Assignment Descriptive Statistics Data Analysis Software Multimethod Studies Linear Regression Intraclass Correlation Coefficient Pearson's Correlation Coefficient Chi Square Test Conceptual Framework Clinical Assessment Tools Implementation Science Clinical Competence Aged: 65+ years Aged, 80 & over Male Female ab: Background: Delirium is missed in over 75% of older adults presenting to the Emergency Department (ED). The study aimed to determine the efficacy of the ED Delirium Detection Program (ED‐DDP) to improve delirium detection while evaluating implementation outcomes. Methods: The ED‐DDP consisted of a train‐the‐trainer model where delirium champions (DCs) trained ED nurses to perform delirium screening using an electronic health record (EHR)‐embedded Brief Confusion Assessment Method (bCAM). The ED‐DDP was implemented across 3 diverse EDs using a stepped‐wedge cluster randomized trial, consisting of control, implementation, and intervention periods. The RE‐AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework guided outcome assessments. Efficacy was defined as delirium detection between control and intervention periods. Implementation outcomes were assessed via quantitative (surveys, training logs, EHR) and qualitative (semi‐structured interviews) methods. Results: Across the 3 ED sites, 94.4% (n = 17/18) of DCs completed delirium training and 94.4% scored ≥ 80% on the post‐workshop assessment (Implementation/Fidelity). Over 90% (91.1%, n = 195/214) of nurses agreed to receive training by DCs (Adoption); the average score during nurse bCAM spot checks was 73.3% (Implementation‐Fidelity). After ED‐DDP implementation, the odds of delirium screening were 11.5 times higher (95% CI: [6.0, 22.3], p < 0.001), when adjusting for time and site clustering (Penetration); screening varied from 6% to 80% across the 3 sites (Reach). The proportion of older adult encounters with a positive delirium screen increased from 0% to 2.2% (p = 0.002; Efficacy). Qualitative data revealed that although DCs and nurses thought delirium screening was a priority for patient care quality and safety, competing priorities were a barrier to consistent and accurate screening (Maintenance). Conclusions: Although a comprehensive ED delirium training program successfully increased delirium screening, detection remained low. These findings suggest that sustainable delirium detection in the ED requires not only robust training but also deeply embedded workflow solutions and clear post‐detection action pathways. pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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