Erica K Husser1, Donna M Fick1, Marie Boltz1, Priyanka Shrestha1, Jonathan Siuta2, Shannon Malloy3, Abigail Overstreet3, Douglas L Leslie4, Long Ngo5,6, Yoojin Jung7, Sharon K Inouye8, Edward R Marcantonio9. 1. The Pennsylvania State University, College of Nursing, University Park, Pennsylvania, USA. 2. Mount Nittany Physician Group, Mount Nittany Medical Center, State College, Pennsylvania, USA. 3. Beth Israel Deaconess Medical Center, Department of General Medicine, Boston, Massachusetts, USA. 4. The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA. 5. Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. 6. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. 7. Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 8. Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. 9. Divisions of General Medicine and Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
BACKGROUND/ OBJECTIVES: An effective and efficient protocol for delirium identification is needed to improve health outcomes for older adults and reduce healthcare costs. This study describes the barriers and facilitators related to the implementation of the ultra-brief confusion assessment method (UB-CAM), a rapid two-step delirium identification protocol (ultra-brief screen, followed by CAM in positives), field tested with hospitalized older adults (70+). DESIGN: A qualitative descriptive design using observational data collection and brief semi-structured interviews. SETTINGS: An urban academic medical center and a community teaching hospital. PARTICIPANTS: Participants included 50 physician hospitalists, 189 registered nurses, and 83 nursing assistants (NAs). MEASUREMENTS: Field researchers guided by a modified multi-level implementation framework, collected observational data as participants administered the UB-CAM (n = 767). Thematic analysis was conducted on five observational categories: structural, organizational, patient, clinician, and innovation. Field notes and brief semi-structured interviews (n = 231) with clinicians, explored the utility, acceptability, and feasibility of the protocol, and supplemented the observations. RESULTS: The UB-CAM was generally positively received by all three clinician types. Six themes describe barriers and/or facilitators to implementing the UB-CAM: (1) physical setting and milieu; (2) practice environment; (3) integrating into role; (4) adaptive techniques; (5) patient responses; and (6) systematic assessment. The composition and interaction of the six themes determined if the theme was expressed as a barrier or facilitator, affirming the importance of context when implementing system-level delirium screening. CONCLUSION: This is one of the first studies to test a two-step process for delirium identification, and to involve NAs in screening, and the findings demonstrate overall support from clinicians for delirium identification, and describe the need for a multifaceted, contextualized, and systemic approach to implementation and evaluation of delirium screening.
BACKGROUND/ OBJECTIVES: An effective and efficient protocol for delirium identification is needed to improve health outcomes for older adults and reduce healthcare costs. This study describes the barriers and facilitators related to the implementation of the ultra-brief confusion assessment method (UB-CAM), a rapid two-step delirium identification protocol (ultra-brief screen, followed by CAM in positives), field tested with hospitalized older adults (70+). DESIGN: A qualitative descriptive design using observational data collection and brief semi-structured interviews. SETTINGS: An urban academic medical center and a community teaching hospital. PARTICIPANTS: Participants included 50 physician hospitalists, 189 registered nurses, and 83 nursing assistants (NAs). MEASUREMENTS: Field researchers guided by a modified multi-level implementation framework, collected observational data as participants administered the UB-CAM (n = 767). Thematic analysis was conducted on five observational categories: structural, organizational, patient, clinician, and innovation. Field notes and brief semi-structured interviews (n = 231) with clinicians, explored the utility, acceptability, and feasibility of the protocol, and supplemented the observations. RESULTS: The UB-CAM was generally positively received by all three clinician types. Six themes describe barriers and/or facilitators to implementing the UB-CAM: (1) physical setting and milieu; (2) practice environment; (3) integrating into role; (4) adaptive techniques; (5) patient responses; and (6) systematic assessment. The composition and interaction of the six themes determined if the theme was expressed as a barrier or facilitator, affirming the importance of context when implementing system-level delirium screening. CONCLUSION: This is one of the first studies to test a two-step process for delirium identification, and to involve NAs in screening, and the findings demonstrate overall support from clinicians for delirium identification, and describe the need for a multifaceted, contextualized, and systemic approach to implementation and evaluation of delirium screening.
Authors: Eeva Hölttä; Marja-Liisa Laakkonen; Jouko V Laurila; Timo E Strandberg; Reijo Tilvis; Hannu Kautiainen; Kaisu H Pitkälä Journal: Am J Geriatr Psychiatry Date: 2011-12 Impact factor: 4.105
Authors: Brianna Rosgen; Karla Krewulak; Danielle Demiantschuk; E Wesley Ely; Judy E Davidson; Henry T Stelfox; Kirsten M Fiest Journal: J Am Geriatr Soc Date: 2018-04-18 Impact factor: 5.562
Authors: Edward R Marcantonio; Donna M Fick; Yoojin Jung; Sharon K Inouye; Marie Boltz; Douglas L Leslie; Erica K Husser; Priyanka Shrestha; Amber Moore; Kimberlyann Sulmonte; Jonathan Siuta; Malaz Boustani; Long H Ngo Journal: Ann Intern Med Date: 2021-11-09 Impact factor: 51.598
Authors: Douglas L Leslie; Donna M Fick; Amber Moore; Sharon K Inouye; Yoojin Jung; Long H Ngo; Marie Boltz; Erica Husser; Priyanka Shrestha; Malaz Boustani; Edward R Marcantonio Journal: J Am Geriatr Soc Date: 2022-04-20 Impact factor: 7.538
Authors: Brett Armstrong; Daniel Habtemariam; Erica Husser; Douglas L Leslie; Marie Boltz; Yoojin Jung; Donna M Fick; Sharon K Inouye; Edward R Marcantonio; Long H Ngo Journal: JAMIA Open Date: 2021-05-20
Authors: Simone Brefka; Gerhard Wilhelm Eschweiler; Dhayana Dallmeier; Michael Denkinger; Christoph Leinert Journal: Z Gerontol Geriatr Date: 2022-01-14 Impact factor: 1.292