Glenn Arendts1,2, Jennefer Love3, Yusuf Nagree2, David Bruce2, Malcolm Hare3, Ian Dey3. 1. Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute for Medical Research, Fiona Stanley Hospital, Murdoch, Western Australia, Australia. 2. University of Western Australia, Nedlands, Western Australia, Australia. 3. Western Australian Department of Health, Perth, Western Australia, Australia.
Abstract
OBJECTIVES: To determine whether a bundled risk screening and warning or action card system improves formal delirium diagnosis and person-centered outcomes in hospitalized older adults. DESIGN: Prospective trial with sequential introduction of screening and interventional processes. SETTING:Two tertiary referral hospitals in Australia. PARTICIPANTS: Individuals aged 65 and older presenting to the emergency department (ED) and not requiring immediate resuscitation (N = 3,905). INTERVENTION: Formal ED delirium screening algorithm and use of a risk warning card with a recommended series of actions for the prevention and management of delirium during the subsequent admission MEASUREMENTS: Delirium diagnosis at hospital discharge, proportion discharged to new assisted living arrangements, in-hospital complications (use of sedation, falls, aspiration pneumonia, death), hospital length of stay. RESULTS: Participants with a positive risk screen were significantly more likely (relative risk = 6.0, 95% confidence interval = 4.9-7.3) to develop delirium, and the proportion of at-risk participants with a positive screen was constant across three study phases. Delirium detection rate in participants undergoing the final intervention (Phase 3) was 12.1% (a 2% absolute and 17% relative increase from the baseline rate) but this was not statistically significant (P = .29), and a similar relative increase was seen over time in participants not receiving the intervention CONCLUSION: A risk screening and warning or action card intervention in the ED did not significantly improve rates of delirium detection or other important outcomes.
RCT Entities:
OBJECTIVES: To determine whether a bundled risk screening and warning or action card system improves formal delirium diagnosis and person-centered outcomes in hospitalized older adults. DESIGN: Prospective trial with sequential introduction of screening and interventional processes. SETTING: Two tertiary referral hospitals in Australia. PARTICIPANTS: Individuals aged 65 and older presenting to the emergency department (ED) and not requiring immediate resuscitation (N = 3,905). INTERVENTION: Formal ED delirium screening algorithm and use of a risk warning card with a recommended series of actions for the prevention and management of delirium during the subsequent admission MEASUREMENTS: Delirium diagnosis at hospital discharge, proportion discharged to new assisted living arrangements, in-hospital complications (use of sedation, falls, aspiration pneumonia, death), hospital length of stay. RESULTS:Participants with a positive risk screen were significantly more likely (relative risk = 6.0, 95% confidence interval = 4.9-7.3) to develop delirium, and the proportion of at-risk participants with a positive screen was constant across three study phases. Delirium detection rate in participants undergoing the final intervention (Phase 3) was 12.1% (a 2% absolute and 17% relative increase from the baseline rate) but this was not statistically significant (P = .29), and a similar relative increase was seen over time in participants not receiving the intervention CONCLUSION: A risk screening and warning or action card intervention in the ED did not significantly improve rates of delirium detection or other important outcomes.
Authors: Christopher R Carpenter; Nada Hammouda; Elizabeth A Linton; Michelle Doering; Ugochi K Ohuabunwa; Kelly J Ko; William W Hung; Manish N Shah; Lee A Lindquist; Kevin Biese; Daniel Wei; Libby Hoy; Lori Nerbonne; Ula Hwang; Scott M Dresden Journal: Acad Emerg Med Date: 2020-12-12 Impact factor: 5.221
Authors: Sangil Lee; Hao Chen; Seikei Hibino; Daniel Miller; Heather Healy; Jacques S Lee; Glenn Arendts; Jin Ho Han; Maura Kennedy; Christopher R Carpenter Journal: J Am Geriatr Soc Date: 2022-03-11 Impact factor: 7.538