Barriers and Facilitators to the Fidelity of Delirium Screening in the Emergency Department: An Ethnographic Approach.
Background: The Geriatric Emergency Department (ED) guidelines recommend screening older adults for delirium using evidence‐based screening tools, but these tools are often underutilized. We aimed to identify barriers and facilitators to implementing an electronic health record (EHR)‐based delirium...
| Publicado en: | Journal of the American Geriatrics Society Vol. 74; no. 1; pp. 43 - 55 |
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| Autores principales: | , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Wiley-Blackwell
Jan2026
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=192265448&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 192265448 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: Jan2026 vid: 74 iid: 1 pid: 480 pub: Wiley-Blackwell artinfo: ui: 192265448 10.1111/jgs.70142 ppf: 43 ppct: 12 formats: tig: atl: Barriers and Facilitators to the Fidelity of Delirium Screening in the Emergency Department: An Ethnographic Approach. aug: au: Carpenter, Kayla P. Bellolio, Fernanda Bartolacci, Manuela Jeffery, Molly M. Bower, Susan M. Southerland, Lauren T. Mullan, Aidan F. Ridgeway, Jennifer L. affil: Department of Emergency Medicine, Mayo Clinic, Rochester Minnesota,, USA Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester Minnesota,, USA Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester Minnesota,, USA Department of Nursing, Mayo Clinic, Rochester Minnesota,, USA Department of Emergency Medicine, The Ohio State University, Columbus Ohio,, USA Department of Biostatistics and Informatics, Mayo Clinic, Rochester Minnesota,, USA su: Nurse-patient relationships Ethnology research Interviewing Content analysis Ethnology Sound recordings Caregivers Medical screening Patients' attitudes Communication barriers Old age Diagnosis of delirium Medical protocols Academic medical centers Research funding Hospital emergency services Descriptive statistics Workflow Electronic health records Research methodology Nurses' attitudes Clinical competence Emergency nurses sug: subj: Nurse-patient relationships Ethnology research Interviewing Content analysis Ethnology Sound recordings Caregivers Medical screening Patients' attitudes Communication barriers Old age All Other Miscellaneous Ambulatory Health Care Services Integrated Record Production/Distribution Sound recording merchant wholesalers Record Production Diagnosis of delirium Medical protocols Academic medical centers Research funding Hospital emergency services Descriptive statistics Workflow Electronic health records Research methodology Nurses' attitudes Clinical competence Emergency nurses keyword: delirium delirium screening emergency department geriatrics implementation science delirium delirium screening emergency department geriatrics implementation science ab: Background: The Geriatric Emergency Department (ED) guidelines recommend screening older adults for delirium using evidence‐based screening tools, but these tools are often underutilized. We aimed to identify barriers and facilitators to implementing an electronic health record (EHR)‐based delirium screening tool as intended. Methods: This mixed methods and focused ethnographic study combined a review of structured delirium screening data with observations of real‐time delirium screenings and semi‐structured in‐person interviews at an academic ED that previously implemented the Delirium Triage Screen (DTS) and Brief Confusion Assessment Method (bCAM) tool. Content analysis of field notes from observations and interview transcripts was guided by the Exploration, Preparation, Implementation, and Sustainment implementation framework. Results: From a total of 40,818 ED visits, 6196 (15.2%) had incomplete screens (i.e., without fidelity). We observed 62 encounters, of which 25 (40.3%) screenings were implemented without fidelity due to (1) not asking the required screening questions, (2) assuming patient responses, or (3) not completing the screen due to uncertainty regarding a patient's baseline mentation. We conducted 32 interviews. Identified barriers included staff prioritization of other tasks (e.g., stroke code, cleaning patients), limited knowledge of the screen's importance and utility, and language discordance. Facilitators included care partners providing baseline mental status information and nurses prefacing the screening to increase patient engagement. Conclusion: The fidelity of ED delirium screening is influenced by an interplay of environmental, patient, provider, and caregiver factors. Fidelity may be improved by focusing education on the importance of screening, training screeners on how to determine whether a patient's mentation is acutely changed, providing clear action steps when a patient screens positive, and addressing how to administer the delirium screen to patients who do not speak English fluently. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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