1
|
Xing H, Zhu S, Liu S, Xia M, Tong S, Li L, Li L. An online delirium detection tool: Cross-cultural adaptation of a Chinese version of the Family Confusion Assessment Method. Aust Crit Care 2024:S1036-7314(24)00026-2. [PMID: 38580485 DOI: 10.1016/j.aucc.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Intensive care unit (ICU) delirium is a common complication in older critically ill patients that has a significant impact. The Family Confusion Assessment Method (FAM-CAM) is a vital tool for assisting family members in identifying delirium; however, no study has yet been reported on the Chinese version of the scale. OBJECTIVES The objective of this study was to translate the FAM-CAM into a Chinese version and to verify its effectiveness for delirium detection in an online patient visit setting. METHODS This was a cross-sectional study. The FAM-CAM was translated to Chinese according to the International Society for Pharmacoeconomics and Outcomes Research guidelines. Patients and family members were recruited to participate in delirium assessments in three ICUs of one hospital. Family members then used the Chinese version of the FAM-CAM to assess for delirium via online visitation, and ICU nurses assessed patients for delirium using the Intensive Care Delirium Screening Checklist (ICDSC). Results were then compared between family members' and nurses' assessments. RESULTS Overall, 190 critically ill patients and 190 family members were included, of whom 117 (61.6%) were assessed for delirium using the Intensive Care Delirium Screening Checklist. The Cohen's kappa coefficient between the Intensive Care Delirium Screening Checklist and FAM-CAM was 0.759 (P < 0.01). The sensitivity of the Chinese version of the FAM-CAM was 0.880, specificity was 0.890, positive predictive value was 0.928, negative predictive value was 0.823, and area under the receiver operating characteristic curve was 0.881 (95% confidence interval: 0.872-0.935, P < 0.01). CONCLUSION The Chinese version of the FAM-CAM was shown to effectively help families detect delirium and was suggested as a crucial tool for assisting ICU nurses in the early identification of delirium. This tool may effectively be used to assess delirium during online visits.
Collapse
Affiliation(s)
- Huanmin Xing
- Intensive Care Unit, Henan Provincial People's Hospital, Henan Province, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Intensive Care Unit, People's Hospital of Zhengzhou University, Henan Province, China; Intensive Care Unit, People's Hospital of Henan University, Henan Province, China
| | - Shichao Zhu
- Intensive Care Unit, Henan Provincial People's Hospital, Henan Province, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Intensive Care Unit, People's Hospital of Zhengzhou University, Henan Province, China; Intensive Care Unit, People's Hospital of Henan University, Henan Province, China
| | - Shiqing Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Henan Province, China.
| | - Ming Xia
- Intensive Care Unit, Henan Provincial People's Hospital, Henan Province, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Intensive Care Unit, People's Hospital of Zhengzhou University, Henan Province, China; Intensive Care Unit, People's Hospital of Henan University, Henan Province, China
| | - Shuaihong Tong
- Intensive Care Unit, Henan Provincial People's Hospital, Henan Province, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Intensive Care Unit, People's Hospital of Zhengzhou University, Henan Province, China; Intensive Care Unit, People's Hospital of Henan University, Henan Province, China
| | - Long Li
- Intensive Care Unit, Henan Provincial People's Hospital, Henan Province, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Intensive Care Unit, People's Hospital of Zhengzhou University, Henan Province, China; Intensive Care Unit, People's Hospital of Henan University, Henan Province, China
| | - Liming Li
- Henan Provincial Key Medicine Laboratory of Nursing, Henan Province, China; Nursing Department, Henan Provincial People's Hospital, Henan Province, China.
| |
Collapse
|
2
|
Zhou C, Wang H, Wang L, Zhou Y, Wu Q. Diagnostic accuracy of the Family Confusion Assessment Method for delirium detection: A systematic review and meta-analysis. J Am Geriatr Soc 2024; 72:892-902. [PMID: 38018490 DOI: 10.1111/jgs.18692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/03/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Delirium is frequently disproportionately under-recognized despite its high prevalence, detrimental impact, and potential lethality. Informant-based delirium detection tools can offer structured assessment and increase the timeliness and frequency of detection. We aimed to examine the diagnostic accuracy of the Family Confusion Assessment Method (FAM-CAM) for delirium detection. METHODS We systematically searched the MEDLINE, EMBASE, PsycINFO, CINAHL, CNKI, WANFANG, and SinoMed databases from January 1988 to December 2022. Two reviewers independently screened studies and evaluated methodological quality using the revised quality assessment of diagnostic accuracy studies (QUADAS-2) tool. A bivariate random effects model was undertaken, and univariable meta-regression was carried out to explore heterogeneity. RESULTS Seven studies with 483 dyads of participants and family caregivers were identified. Pooled sensitivity and specificity were 0.74 (95% CI: 0.59, 0.86) and 0.91 (95% CI: 0.83, 0.95), respectively, with an area under curve (AUC) of 0.91. The positive likelihood ratio was 8.27 (95% CI: 3.97, 17.25), and the negative likelihood ratio was 0.28 (95% CI: 0.16, 0.50). Settings impacted specificity (p = 0.02). CONCLUSIONS Available evidence indicates that FAM-CAM exhibits moderate sensitivity and high specificity for delirium screening in adults. The FAM-CAM is concise and easy to use, making it appropriate for routine clinical practice, which might benefit early delirium detection and potentially foster delirium management. PROSPERO REGISTRATION NUMBER CRD42022378742.
Collapse
Affiliation(s)
- Chenxi Zhou
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lan Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanrong Zhou
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiansheng Wu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
3
|
Leah V, Ngwu L. Identifying the relationship between delirium and falls. Nurs Older People 2023; 35:22-27. [PMID: 36810921 DOI: 10.7748/nop.2023.e1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 02/24/2023]
Abstract
Delirium, which may present as acute fluctuation in arousal and attention and changes in a person's behaviours, can increase the risk of falls, while a fall can increase the risk of developing delirium. There is, therefore, a fundamental relationship between delirium and falls. This article describes the main types of delirium and the challenges associated with recognition of the condition and discusses the relationship between delirium and falls. The article also describes some of the validated tools used to screen patients for delirium and includes two brief case studies to illustrate this in practice.
Collapse
Affiliation(s)
- Vicki Leah
- University of East London, London, England
| | | |
Collapse
|
4
|
Recognition of Delirium Superimposed on Dementia: Is There an Ideal Tool? Geriatrics (Basel) 2023; 8:geriatrics8010022. [PMID: 36826364 PMCID: PMC9957529 DOI: 10.3390/geriatrics8010022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Delirium in persons with dementia (DSD) is a common occurrence. Over the past three decades, several tools have been developed and validated to diagnose delirium, yet there is still a shortage of tools recommended in persons with dementia and there is a lack of sufficient research on the accuracy of performance of such tools in this growing population. The purpose of this article is to (1) conduct a clinical review of the detection of DSD across settings of care by formal health care professionals and informal family members and care partners; (2) identify barriers and facilitators to detection and highlight delirium tools that have been tested in person with dementia; and (3) make recommendations for future research, practice, and policy. Given this review, an "ideal" tool for DSD would point to tools being brief, easy to integrate into the EMR, and accurate with at least 90% accuracy given the poor outcomes associated with delirium and DSD. Knowing the baseline and communication between family members and healthcare professionals should be a top priority for education, research, and health systems policy. More work is needed in better understanding DSD and optimizing and standardizing feature assessment, especially the acute change feature at the bedside for DSD.
Collapse
|
5
|
Julian P, Ploeg J, Kaasalainen S, Markle-Reid M. Building collaborative relationships with family caregivers of hospitalized older persons with delirium superimposed on dementia: A qualitative study. J Adv Nurs 2022. [PMID: 36196458 DOI: 10.1111/jan.15449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/06/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
AIMS To explore experiences of family caregivers providing support to older persons with delirium superimposed on dementia in acute care hospitals, their role in detection and management of this condition, and support they require. DESIGN This study has an exploratory-descriptive design using interpretive description methodology. METHODS Semi-structured interviews were conducted with nine caregivers from January to April 2020. Interview transcripts underwent thematic analysis. FINDINGS Three themes were identified: (1) family caregivers found delirium superimposed on dementia to be an overwhelming experience, (2) family caregivers can play an important role in the detection and management of delirium superimposed on dementia and (3) family caregivers' experiences were influenced by the nature of their relationship with the health care team. Family caregivers found the experience distressing and felt unprepared to face the condition. Family caregivers also possessed knowledge helpful in detecting acute changes and caring for the older person. Family caregivers' relationships with the health care team varied: some felt supported by the team, while others experienced a power imbalance, characterized by lack of communication and opportunities to participate in care. CONCLUSIONS Family caregivers were distressed to see family members hospitalized with delirium superimposed on dementia. Family caregivers are also ideally positioned to detect the condition and participate in care. However, power imbalances remain, leaving family caregivers feeling disempowered and believing the health care team had more control over the older person's care. IMPACT Findings highlight the need for strategies to address the distress and disempowerment experienced by family caregivers of hospitalized older persons with delirium superimposed on dementia. By building collaborative relationships, nurses and other health care team members can help family caregivers navigate the complex experience with delirium superimposed on dementia and reduce distress, with the ultimate goal of facilitating family caregivers' ability to care for older persons in the community. NO PATIENT OR PUBLIC CONTRIBUTION While the study participants are members of the public, this population was not involved in the study design and analysis. This method aligns with interpretive description, where researchers are not just a medium through which participants speak, but also interpretive instruments who discern insights not accessible to persons who may be familiar with only a single case.
Collapse
Affiliation(s)
- Patricia Julian
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Maureen Markle-Reid
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
6
|
Hur HJ, Jang YN, Park HY, Lee YS, Ro DH, Kang B, Song KH, Park HY. A prospective study of remote delirium screening using the modified K-4AT for COVID-19 inpatients. Front Psychiatry 2022; 13:976228. [PMID: 36061272 PMCID: PMC9433641 DOI: 10.3389/fpsyt.2022.976228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Delirium is a neuropsychiatric condition strongly associated with poor clinical outcomes such as high mortality and long hospitalization. In the patients with Coronavirus disease 2019 (COVID-19), delirium is common and it is considered as one of the risk factors for mortality. For those admitted to negative-pressure isolation units, a reliable, validated and contact-free delirium screening tool is required. Materials and methods We prospectively recruited eligible patients from multiple medical centers in South Korea. Delirium was evaluated using the Confusion Assessment Method (CAM) and 4'A's Test (4AT). The attentional component of the 4AT was modified such that respondents are required to count days, rather than months, backward in Korean. Blinded medical staff evaluated all patients and determined whether their symptoms met the delirium criteria of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). An independent population of COVID-19 patients was used to validate the 4AT as a remote delirium screening tool. We calculated the area under the receiver operating characteristic curve (AUC). Results Out of 286 general inpatients, 28 (9.8%) inpatients had delirium. In this population, the patients with delirium were significantly older (p = 0.018) than the patients without delirium, and higher proportion of males were included in the delirium group (p < 0.001). The AUC of the 4AT was 0.992 [95% confidence interval (CI) 0.983-1.000] and the optimal cutoff was at 3. Of the independent COVID-19 patients, 13 of 108 (12.0%) had delirium. Demographically, the COVID-19 patients who had delirium only differed in employment status (p = 0.047) from the COVID-19 patients who did not have delirium. The AUC for remote screening using the 4AT was 0.996 (0.989-1.000). The optimal cutoff of this population was also at 3. Conclusion The modified K-4AT had acceptable reliability and validity when used to screen inpatients for delirium. More importantly, the 4AT efficiently screened for delirium during remote evaluations of COVID-19 patients, and the optimal cutoff was 3. The protocol presented herein can be used for remote screening of delirium using the 4AT.
Collapse
Affiliation(s)
- Hyun Jung Hur
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Yu Na Jang
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Seok Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Beodeul Kang
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Kyoung-Ho Song
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hye Youn Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul, South Korea
| |
Collapse
|
7
|
Greindl S, Weiss B, Magnolini R, Lingg C, Mayer H, Schaller SJ. Detection of delirium by family members in the intensive care unit: Translation, Cross-Cultural adaptation and validation of the Family Confusion Assessment Method for the German-Speaking area. J Adv Nurs 2022; 78:3207-3216. [PMID: 35301750 DOI: 10.1111/jan.15227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/20/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was the translation, cross-cultural adaptation and validation of the Family Confusion Assessment Method in critically ill patients. BACKGROUND Delirium is a frequently unrecognized disorder in critically ill patients. Visiting family members might be the first to notice subtle changes in a patient's cognition and behaviour. The Family Confusion Assessment Method was developed to detect delirium by family members, but has not been available for the German-speaking area yet. DESIGN A prospective validation study was conducted between January 2020 and October 2020. METHODS The Family Confusion Assessment Method was translated into German according to the Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes. Subsequently, we compared the Family Confusion Assessment Method with the Confusion Assessment Method for the Intensive Care Unit in critically ill patients and their family members in a medical intensive care unit in Germany. RESULTS We included 50 dyads of critically ill patients and their family members. The prevalence of delirium measured by Confusion Assessment Method for the Intensive Care Unit was 44%. Cohen's kappa coefficient was 0.84. The German Family Confusion Assessment Method had a high sensitivity of 95.5% and specificity of 89.3%. The positive predictive value and negative predictive value were 87.5% and 96.2% respectively. CONCLUSIONS These findings suggest that the German Family Confusion Assessment Method is an accurate assessment tool for delirium detection in the intensive care unit by family members. Furthermore, the results indicate that family members may identify delirium by the Family Confusion Assessment Method without prior training. IMPACT Collaborating medical staff with patients' family members to detect delirium in the intensive care unit may lead to early recognition of delirium.
Collapse
Affiliation(s)
- Stephanie Greindl
- Department of Nursing, University Hospital Regensburg, Regensburg, Germany.,Institute of Nursing Science, University of Vienna, Vienna, Austria.,Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Björn Weiss
- Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK/CCM), Berlin, Germany
| | - Raphael Magnolini
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Charlotte Lingg
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Hanna Mayer
- Institute of Nursing Science, University of Vienna, Vienna, Austria.,Division Nursing Science, Person Centred Care, Karl Landsteiner University for Health Science, Krems, Austria
| | - Stefan J Schaller
- Charité - Universitätsmedizin Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK/CCM), Berlin, Germany.,Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care, Munich, Germany
| |
Collapse
|
8
|
Shahid A, Rosgen BK, Krewulak KD, Lorenzetti DL, Foster N, Sept BG, Leigh JP, Stelfox HT, Fiest KM. Incorporating and evaluating citizen engagement in health research: a scoping review protocol. Syst Rev 2021; 10:260. [PMID: 34583771 PMCID: PMC8480041 DOI: 10.1186/s13643-021-01812-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Citizen engagement in research is an emerging practice that involves members of the general public in research processes such as priority setting, planning, decision-making, research conduct, implementation, evaluation, and dissemination. Engaging citizens in research, particularly health research, increases the relevance of study findings, minimizes waste by facilitating stewardship over resources, and builds public trust in the research. While several existing frameworks guide the application of citizen engagement principles to health research, it is unclear how citizen engagement can be utilized to maximize benefits and minimize risks and challenges in health research. To address the gaps in knowledge around citizen engagement in health research, we propose a scoping review to synthesize the state of knowledge on methods to incorporate and evaluate citizen engagement in research. A protocol is presented in this manuscript. METHODS The methodology for our scoping review is guided by Arksey and O' Malley's framework for scoping reviews, and additional recommendations by Levac and colleagues. We will include peer-reviewed and gray literature that report on citizen engagement in health research (including biomedical, clinical, health systems and services, and social, cultural, environmental and population health) and report method(s) to conduct, measure, or evaluate citizen engagement. We will systematically search electronic databases (MEDLINE, EMBASE, CINAHL, JSTOR, PsycINFO, Scopus, and Science Direct) from inception onwards and search relevant organizations' websites for additional studies, frameworks, and reports on citizen engagement. Title and abstract and full-text citations will be screened independently and in duplicate. Data will be extracted independently and in duplicate, including document characteristics, citizen engagement definitions and goals, and outcomes of citizen engagement (e.g., barriers, facilitators). DISCUSSION This review will synthesize the definitions, goals, methods, outcomes, and significance of citizen engagement in health research, as well as any potential barriers, facilitators, and challenges outlined in existing literature. The findings will provide an evidence-based foundation for developing new or improved guidance for citizen engagement in health research. Overall, we anticipate that our scoping review will be a preliminary step to meaningful engagement of citizens in research and strengthen the relationship between the scientific community and the public through transparency and collaboration. SYSTEMATIC REVIEW REGISTRATION Open Science Framework https://osf.io/hzcbr .
Collapse
Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Brianna K Rosgen
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Diane L Lorenzetti
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Nadine Foster
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Dalhousie University, Halifax, Nova Scotia, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada. .,Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
9
|
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of family-administered tools to detect delirium in critically ill patients. DESIGN Diagnostic accuracy study. SETTING Large, tertiary care academic hospital in a single-payer health system. PATIENTS Consecutive, eligible patients with at least one family member present (dyads) and a Richmond Agitation-Sedation Scale greater than or equal to -3, no primary direct brain injury, the ability to provide informed consent (both patient and family member), the ability to communicate with research staff, and anticipated to remain admitted in the ICU for at least a further 24 hours to complete all assessments at least once. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Family-administered delirium assessments (Family Confusion Assessment Method and Sour Seven) were completed once daily. A board-certified neuropsychiatrist and team of ICU research nurses conducted the reference standard assessments of delirium (based on Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, criteria) once daily for a maximum of 5 days. The mean age of the 147 included patients was 56.1 years (SD, 16.2 yr), 61% of whom were male. Family members (n = 147) were most commonly spouses (n = 71, 48.3%) of patients. The area under the receiver operating characteristic curve on the Family Confusion Assessment Method was 65.0% (95% CI, 60.0-70.0%), 71.0% (95% CI, 66.0-76.0%) for possible delirium (cutpoint of 4) on the Sour Seven and 67.0% (95% CI, 62.0-72.0%) for delirium (cutpoint of 9) on the Sour Seven. These area under the receiver operating characteristic curves were lower than the Intensive Care Delirium Screening Checklist (standard of care) and Confusion Assessment Method for ICU. Combining the Family Confusion Assessment Method or Sour Seven with the Intensive Care Delirium Screening Checklist or Confusion Assessment Method for ICU resulted in area under the receiver operating characteristic curves that were not significantly better, or worse for some combinations, than the Intensive Care Delirium Screening Checklist or Confusion Assessment Method for ICU alone. Adding the Family Confusion Assessment Method and Sour Seven to the Intensive Care Delirium Screening Checklist and Confusion Assessment Method for ICU improved sensitivity at the expense of specificity. CONCLUSIONS Family-administered delirium detection is feasible and has fair, but lower diagnostic accuracy than clinical assessments using the Intensive Care Delirium Screening Checklist and Confusion Assessment Method for ICU. Family proxy assessments are essential for determining baseline cognitive function. Engaging and empowering families of critically ill patients warrant further study.
Collapse
|
10
|
McClay R. Implementation of the Family HELP Protocol: A Feasibility Project for a West Texas ICU. Healthcare (Basel) 2021; 9:healthcare9020146. [PMID: 33540501 PMCID: PMC7912935 DOI: 10.3390/healthcare9020146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 11/24/2022] Open
Abstract
The purpose of this project was to determine if bedside intensive care unit (ICU) nurse buy-in to the Family Hospital Elder Life Program (HELP) protocol was sufficient to make implementation feasible at one county hospital in West Texas. Surveys were anonymous with ballot box collection being available to the bedside ICU nurses for one week each. Questions were based on literature findings of expected outcomes, identified barriers and facilitators, Calgary Family Intervention Method framework domains, and the Centers for Disease Control and Prevention Framework for program evaluation. Outcome measures were taken from the stated aims of the project and evaluated from paired baseline and summative survey questions. Survey participation was approximately half of nurses employed in the studied ICU. Analysis of the surveys showed a positive perception of family presence decreasing patient delirium symptoms, and a positive perception of the Family HELP protocol. The results described a high perception of family members as partners in care and high intention to implement the Family HELP protocol, indicating strong support of a full implementation of the protocol. The high level of bedside nurse buy-in present in this study has large implications for successful implementation of the Family HELP protocol in the near future, with sustainability and continued use supported by potential inclusion of the task in the electronic health record charting.
Collapse
Affiliation(s)
- Rebecca McClay
- School of Science, Technology, Engineering, and Math, American Public University System, Charles Town, WV 25414, USA
| |
Collapse
|
11
|
Husser EK, Fick DM, Boltz M, Shrestha P, Siuta J, Malloy S, Overstreet A, Leslie DL, Ngo L, Jung Y, Inouye SK, Marcantonio ER. Implementing a Rapid, Two-Step Delirium Screening Protocol in Acute Care: Barriers and Facilitators. J Am Geriatr Soc 2021; 69:1349-1356. [PMID: 33474729 DOI: 10.1111/jgs.17026] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 12/19/2022]
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.
Collapse
Affiliation(s)
- Erica K Husser
- The Pennsylvania State University, College of Nursing, University Park, Pennsylvania, USA
| | - Donna M Fick
- The Pennsylvania State University, College of Nursing, University Park, Pennsylvania, USA
| | - Marie Boltz
- The Pennsylvania State University, College of Nursing, University Park, Pennsylvania, USA
| | - Priyanka Shrestha
- The Pennsylvania State University, College of Nursing, University Park, Pennsylvania, USA
| | - Jonathan Siuta
- Mount Nittany Physician Group, Mount Nittany Medical Center, State College, Pennsylvania, USA
| | - Shannon Malloy
- Beth Israel Deaconess Medical Center, Department of General Medicine, Boston, Massachusetts, USA
| | - Abigail Overstreet
- Beth Israel Deaconess Medical Center, Department of General Medicine, Boston, Massachusetts, USA
| | - Douglas L Leslie
- The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Long Ngo
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yoojin Jung
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sharon K Inouye
- Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward R Marcantonio
- Divisions of General Medicine and Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Fiest KM, Krewulak KD, Sept BG, Spence KL, Davidson JE, Ely EW, Soo A, Stelfox HT. A study protocol for a randomized controlled trial of family-partnered delirium prevention, detection, and management in critically ill adults: the ACTIVATE study. BMC Health Serv Res 2020; 20:453. [PMID: 32448187 PMCID: PMC7245836 DOI: 10.1186/s12913-020-05281-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 12/24/2022] Open
Abstract
Background Delirium is very common in critically ill patients admitted to the intensive care unit (ICU) and results in negative long-term outcomes. Family members are also at risk of long-term complications, including depression and anxiety. Family members are frequently at the bedside and want to be engaged; they know the patient best and may notice subtle changes prior to the care team. By engaging family members in delirium care, we may be able to improve both patient and family outcomes by identifying delirium sooner and capacitating family members in care. Methods The primary aim of this study is to determine the effect of family-administered delirium prevention, detection, and management in critically ill patients on family member symptoms of depression and anxiety, compared to usual care. One-hundred and ninety-eight patient-family dyads will be recruited from four medical-surgical ICUs in Calgary, Canada. Dyads will be randomized 1:1 to the intervention or control group. The intervention consists of family-partnered delirium prevention, detection, and management, while the control group will receive usual care. Delirium, depression, and anxiety will be measured using validated tools, and participants will be followed for 1- and 3-months post-ICU discharge. All analyses will be intention-to-treat and adjusted for pre-identified covariates. Ethical approval has been granted by the University of Calgary Conjoint Health Research Ethics Board (REB19–1000) and the trial registered. The protocol adheres to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist. Discussion Critically ill patients are frequently unable to participate in their own care, and partnering with their family members is particularly important for improving experiences and outcomes of care for both patients and families. Trial registration Registered September 23, 2019 on Clinicaltrials.gov NCT04099472.
Collapse
Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada. .,Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada. .,Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | - Karla D Krewulak
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Krista L Spence
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Judy E Davidson
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, California, USA
| | - E Wesley Ely
- Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (VA GRECC), Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada.,Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.,Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| |
Collapse
|
13
|
Shrestha P, Fick DM. Family caregiver's experience of caring for an older adult with delirium: A systematic review. Int J Older People Nurs 2020; 15:e12321. [PMID: 32374518 DOI: 10.1111/opn.12321] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/05/2023]
Abstract
AIM To enhance understanding of how family caregivers perceive the experience of caring for an older adult with delirium across care settings and to identify the challenges in recognising and managing delirium to inform future research and best practices. METHOD A systematic literature review was conducted in five databases per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Primary or secondary peer-reviewed articles published between 1987 and October 2018 describing the experiences of family caregivers caring for older adults with delirium or delirium superimposed on dementia were included in the review. Mixed Method Appraisal Tool (MMAT) was used to evaluate the methodological quality. A thematic synthesis of results was conducted to extract relevant data as per the aims of the study. RESULTS Eighteen articles met the eligibility criteria, which were reviewed and analysed in regard to purpose, sample, research design, variables and results. Seven themes emerged in the process. The current challenges and gaps in our knowledge of this phenomenon have also been highlighted, which should be helpful to inform best practices, and finally, an agenda for future research is proposed. CONCLUSION Family caregivers are an important partner in the detection and management of delirium. The impact of caring for an older adult with delirium on the family caregivers should not be overlooked. This paper highlights the dearth of research on family caregiver's experience of caring for older adults with delirium and even less in the context of delirium superimposed on dementia. More research is required to further understand the family caregiver's experience and their challenges in order to support them in their caregiving role and to determine their needs and preferences of being involved in the plan of care. IMPLICATIONS FOR PRACTICE These findings suggest that family caregivers are a valuable resource in the recognition and management of delirium and should be included as care partners in the health care team, while also catering to their health and well-being in the process.
Collapse
Affiliation(s)
| | - Donna M Fick
- Penn State College of Nursing, State College, PA, USA
| |
Collapse
|
14
|
Mailhot T, Darling C, Ela J, Malyuta Y, Inouye SK, Saczynski J. Family Identification of Delirium in the Emergency Department in Patients With and Without Dementia: Validity of the Family Confusion Assessment Method (FAM-CAM). J Am Geriatr Soc 2020; 68:983-990. [PMID: 32274799 DOI: 10.1111/jgs.16438] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 01/24/2020] [Accepted: 02/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the ability of the family-rated Family Confusion Assessment Method (FAM-CAM) to identify delirium in the emergency department (ED) among patients with and without dementia, as compared to the reference-standard Confusion Assessment Method (CAM). DESIGN Validation study. SETTING Urban academic ED. PARTICIPANTS Dyads of ED patients, aged 70 years and older, and their family caregivers (N = 108 dyads). MEASUREMENTS A trained reference standard interviewer performed a cognitive screen, delirium symptom assessment, and scored the CAM. The caregiver self-administered the FAM-CAM. Dementia was assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the medical record. For concurrent validity, performance of the FAM-CAM was compared to the CAM. For predictive validity, clinical outcomes (ED visits, hospitalization, and mortality) over 6 months were compared in FAM-CAM positive and negative patients, controlling for age, sex, comorbidity, and cognitive status. RESULTS Among the 108 patients, 30 (28%) were CAM positive for delirium and 58 (54%) presented with dementia. The FAM-CAM had a specificity of 83% and a negative predictive value of 83%. Most false negatives (n = 9 of 13, 69%) were due to caregivers not identifying the inattention criteria for delirium on the FAM-CAM. In patients with dementia, sensitivity was higher than in patients without (61% vs 43%). In adjusted models, a hospitalization in the following 6 months was more than three times as likely in FAM-CAM positive compared to negative patients (odds ratio = 3.4; 95% confidence interval = 1.2-9.3). CONCLUSIONS Among patients with and without dementia, the FAM-CAM shows qualities that are important in the ED setting for identification of delirium. Using the FAM-CAM as part of a systematic screening strategy for the ED, in which families' assessments could supplement healthcare professionals' assessments, is promising. J Am Geriatr Soc 68:983-990, 2020.
Collapse
Affiliation(s)
- Tanya Mailhot
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Chad Darling
- Department of Emergency Medicine, UMass Memorial Health Care, Worcester, Massachusetts, USA
| | - Jillian Ela
- Neurological Associates of Albany, Albany, New York, USA
| | - Yelena Malyuta
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sharon K Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Aging Brain Center, Marcus Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jane Saczynski
- Department of Pharmacy and Health System Sciences, Northeastern University, Boston, Massachusetts, USA
| |
Collapse
|
15
|
Goldfarb M, Bibas L, Burns K. Patient and Family Engagement in Care in the Cardiac Intensive Care Unit. Can J Cardiol 2020; 36:1032-1040. [PMID: 32533931 DOI: 10.1016/j.cjca.2020.03.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/26/2022] Open
Abstract
Hospitalization in the cardiac intensive care unit can be a stressful experience for patients and families. Family members often feel overwhelmed by the severity of their loved one's illness, powerless to affect their care, and struggle to comprehend information regarding their loved one's current health status and treatment plan. Consequently, up to half of family members might develop psychological symptoms (depression, generalized anxiety, and post-traumatic stress disorder) and a syndrome of enduring psychological, cognitive, or emotional disturbances. Patient and family engagement (PFE) is an emerging approach that empowers family members to become essential and active partners in care delivery and research. In the patient care context, the goal of PFE is to improve the care experience and achieve better outcomes for patients and family members. As a result of societal trends, family members increasingly wish to directly participate in their relative's care and be informed and involved in decision-making. There is growing evidence that engaging family members in care improves patient- and family-important outcomes after acute and critical illness. Although the role for PFE in care and research has been explored in the general critical care context, efforts to inform clinicians who manage patients with acute cardiovascular disease about the relevance of PFE are limited. In this review, we describe opportunities for PFE in the cardiac intensive care unit, outline the current evidence base for PFE in patient care, identify barriers to PFE and how to overcome them, and highlight knowledge gaps and areas for future investigations.
Collapse
Affiliation(s)
- Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Lior Bibas
- Division of Cardiology, Pierre-Boucher Hospital, Longueuil, Quebec, Canada
| | - Karen Burns
- Division of Critical Care Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
16
|
Abstract
Delirium is a common and underdiagnosed problem in hospitalized older adults. It is associated with an increased risk of poor cognitive and functional outcomes, institutionalization, and death. Timely diagnosis of delirium and non-pharmacological prevention and management strategies can improve patient outcomes. The Confusion Assessment Method (CAM) is the most widely used clinical assessment tool for the diagnosis of delirium. Multiple variations of the CAM have been developed for ease of administration and for the unique needs of specific patient populations, including the 3-min diagnostic CAM (3D CAM), CAM-Intensive Care Unit (CAM-ICU), Delirium Triage Screen (DTS)/Brief CAM (b-CAM), 4AT tool, and ultrabrief delirium assessment. Strong evidence supports the effectiveness of nonpharmacologic strategies as the primary intervention for the prevention of delirium. Multicomponent delirium prevention strategies can reduce the incidence of delirium by 40%. Investigation of underlying medical precipitants and optimization of non-pharmacological interventions are first line in the management of delirium. Despite a lack of evidence supporting use of antipsychotics, low dose antipsychotics remain second line for off-label treatment of distressing psychoses and/or agitated behaviors that are refractory to non-pharmacological behavioral interventions and pose an imminent risk of harm to self or others. Any antipsychotic prescription for delirium should be accompanied by an appropriate taper plan. Follow up with primary care providers on discharge from hospital for ongoing screening of cognitive impairment is important.
Collapse
Affiliation(s)
- Katie M Rieck
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sandeep Pagali
- Division of Hospital Internal Medicine, and Division of Geriatrics and Gerontology, Mayo Clinic, Rochester, MN, USA
| | - Donna M Miller
- Division of Hospital Internal Medicine, and Division of Geriatrics and Gerontology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
17
|
Vlisides PE, Ragheb JW, Leis A, Schoettinger A, Hickey K, McKinney A, Brooks J, Zierau M, Norcott A, Yang S, Avidan MS, Min L. Recommendations and Alerting for Delirium Alleviation in Real-Time (RADAR): Protocol for a pilot randomized controlled trial. F1000Res 2019; 8:1683. [PMID: 32934794 PMCID: PMC7471625 DOI: 10.12688/f1000research.20597.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Delirium is a common and serious complication of major surgery for older adults. Postoperative social and behavioral support (e.g., early mobilization, mealtime assistance) may reduce the incidence and impact of delirium, and these efforts are possible with proactive patient-care programs. This pilot trial tests the hypothesis that a multicomponent decision support system, which sends automated alerts and recommendations to patient-care programs and family members for high-risk patients, will improve the postoperative environment for neurocognitive and clinical recovery. Methods: This will be a randomized, controlled, factorial pilot trial at a large academic medical center. High-risk, non-cardiac surgery patients (≥70 years old) will be recruited. Patients will be allocated to a usual care group (n=15), Hospital Elder Life Program (HELP)-based paging system (n=15), family-based paging system (n=15), or combined HELP- and family-based system (n=15). The primary outcome will be the presence of delirium, defined by positive long-form Confusion Assessment Method screening. Secondary outcomes will include additional HELP- and family-based performance metrics along with various neurocognitive and clinical recovery measures. Exploratory outcomes include the incidence of positive family-based delirium assessments post-discharge, 36-item Short Form Survey, PROMIS Cognitive Function Abilities Subset 4a, and 30-day readmission rates. Ethics and dissemination: This trial has received approval by the University of Michigan Medical Institutional Review Board (IRBMED). Dissemination plans include presentation at scientific conferences, publication in medical journals, and distribution via educational and news media. Registration: ClinicalTrials.gov Identifier NCT04007523, registered on 7/3/2019.
Collapse
Affiliation(s)
- Phillip E. Vlisides
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Jacqueline W. Ragheb
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | - Aleda Leis
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | | | - Kim Hickey
- University of Michigan School of Nursing, Ann Arbor, MI, 48109, USA
| | - Amy McKinney
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | - Joseph Brooks
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | - Mackenzie Zierau
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | - Alexandra Norcott
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, 48105, USA
| | - Shirley Yang
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | - Michael S. Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Lillian Min
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Geriatric Research Education and Clinical Care, VA Ann Arbor Healthcare System, Ann Arbor, MI, 48105, USA
| |
Collapse
|
18
|
Vlisides PE, Ragheb JW, Leis A, Schoettinger A, Hickey K, McKinney A, Brooks J, Zierau M, Norcott A, Yang S, Avidan MS, Min L. Recommendations and Alerting for Delirium Alleviation in Real-Time (RADAR): Protocol for a pilot randomized controlled trial. F1000Res 2019; 8:1683. [PMID: 32934794 PMCID: PMC7471625 DOI: 10.12688/f1000research.20597.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 03/30/2024] Open
Abstract
Background: Delirium is a common and serious complication of major surgery for older adults. Postoperative social and behavioral support (e.g., early mobilization, mealtime assistance) may reduce the incidence and impact of delirium, and these efforts are possible with proactive patient-care programs. This pilot trial tests the hypothesis that a multicomponent decision support system, which sends automated alerts and recommendations to patient-care programs and family members for high-risk patients, will improve the postoperative environment for neurocognitive and clinical recovery. Methods: This will be a randomized, controlled, factorial pilot trial at a large academic medical center. High-risk, non-cardiac surgery patients (≥70 years old) will be recruited. Patients will be allocated to a usual care group (n=15), Hospital Elder Life Program (HELP)-based paging system (n=15), family-based paging system (n=15), or combined HELP- and family-based system (n=15). The primary outcome will be the presence of delirium, defined by positive long-form Confusion Assessment Method screening. Secondary outcomes will include additional HELP- and family-based performance metrics along with various neurocognitive and clinical recovery measures. Exploratory outcomes include the incidence of positive family-based delirium assessments post-discharge, 36-item Short Form Survey, PROMIS Cognitive Function Abilities Subset 4a, and 30-day readmission rates. Ethics and dissemination: This trial has received approval by the University of Michigan Medical Institutional Review Board (IRBMED). Dissemination plans include presentation at scientific conferences, publication in medical journals, and distribution via educational and news media. Registration: ClinicalTrials.gov Identifier NCT04007523, registered on 7/3/2019.
Collapse
Affiliation(s)
- Phillip E. Vlisides
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Jacqueline W. Ragheb
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | - Aleda Leis
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | | | - Kim Hickey
- University of Michigan School of Nursing, Ann Arbor, MI, 48109, USA
| | - Amy McKinney
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | - Joseph Brooks
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | - Mackenzie Zierau
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | - Alexandra Norcott
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, 48105, USA
| | - Shirley Yang
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48170, USA
| | - Michael S. Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Lillian Min
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Geriatric Research Education and Clinical Care, VA Ann Arbor Healthcare System, Ann Arbor, MI, 48105, USA
| |
Collapse
|
19
|
Krewulak KD, Sept BG, Stelfox HT, Ely EW, Davidson JE, Ismail Z, Fiest KM. Feasibility and acceptability of family administration of delirium detection tools in the intensive care unit: a patient-oriented pilot study. CMAJ Open 2019; 7:E294-E299. [PMID: 31028053 PMCID: PMC6488481 DOI: 10.9778/cmajo.20180123] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Family-administered delirium detection tools may serve as valuable diagnostic adjuncts because family caregivers may be better able than providers to detect changes in patient cognition and behaviour from pre-illness levels of functioning. The aim of this pilot study was to assess the feasibility and acceptability of family-administered tools to detect delirium in critically ill patients. METHODS In this single-centre pilot tool validation study conducted in August and September 2017, eligible family caregivers used the Family Confusion Assessment Method (FAM-CAM) and the Sour Seven questionnaire to detect delirium during the patient's intensive care unit (ICU) stay. We calculated descriptive statistics for all study variables. Patients and family caregivers were involved as research partners throughout the study. A patient-orient research approach was taken, engaging patients and family caregivers as full partners. RESULTS Of 141 patients admitted to the ICU, 75 were eligible, of whom 53 were approached; 21 patients (40%), 23/38 family caregivers (60%) and 17/38 dyads (i.e., patient and family caregiver enrolled together) (45%) consented to participate. The most common reason for nonenrolment was refusal by the family, who commonly reported feeling overwhelmed. The completion rate for the FAM-CAM and Sour Seven questionnaire was 74% (17/23). Among 13 dyads, family caregivers detected delirium in 5 patients (38%) using the FAM-CAM, and delirium or possible delirium in 8 patients (62%) using the Sour Seven questionnaire, whereas trained research assistants detected delirium in 8 patients (62%) using the Confusion Assessment Method for the Intensive Care Unit 7 and the Richmond Agitation-Sedation Scale (κ coefficient for agreement between the former and the FAM-CAM and Sour Seven questionnaire 0.62 and 0.85, respectively). INTERPRETATION Administration of the FAM-CAM and Sour Seven questionnaire by family caregivers to detect delirium in the ICU is feasible and acceptable, although, as with most family engagement strategies, it was not desired by all. Results from this pilot study support a definitive study with a larger sample to enable calculation of inferential statistics, but additional recruitment strategies are necessary to improve the response rate. Trial registration: Clinicaltrials.gov, no. NCT03379129.
Collapse
Affiliation(s)
- Karla D Krewulak
- Departments of Critical Care Medicine (Krewulak, Sept, Stelfox, Fiest), Community Health Sciences (Stelfox, Ismail, Fiest) and Psychiatry (Ismail), O'Brien Institute for Public Health (Stelfox, Ismail, Fiest) and Hotchkiss Brain Institute (Ismail), Cumming School of Medicine, University of Calgary; Critical Care Strategic Clinical Network (Krewulak, Sept, Stelfox, Fiest), Alberta Health Services, Calgary, Alta.; Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center (Ely) and Critical Illness, Brain Dysfunction, and Survivorship Center (Ely), Vanderbilt University Medical Center, Nashville, Tenn.; Department of Education, Development and Research (Davidson), University of California, San Diego Health, San Diego, Calif
| | - Bonnie G Sept
- Departments of Critical Care Medicine (Krewulak, Sept, Stelfox, Fiest), Community Health Sciences (Stelfox, Ismail, Fiest) and Psychiatry (Ismail), O'Brien Institute for Public Health (Stelfox, Ismail, Fiest) and Hotchkiss Brain Institute (Ismail), Cumming School of Medicine, University of Calgary; Critical Care Strategic Clinical Network (Krewulak, Sept, Stelfox, Fiest), Alberta Health Services, Calgary, Alta.; Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center (Ely) and Critical Illness, Brain Dysfunction, and Survivorship Center (Ely), Vanderbilt University Medical Center, Nashville, Tenn.; Department of Education, Development and Research (Davidson), University of California, San Diego Health, San Diego, Calif
| | - Henry T Stelfox
- Departments of Critical Care Medicine (Krewulak, Sept, Stelfox, Fiest), Community Health Sciences (Stelfox, Ismail, Fiest) and Psychiatry (Ismail), O'Brien Institute for Public Health (Stelfox, Ismail, Fiest) and Hotchkiss Brain Institute (Ismail), Cumming School of Medicine, University of Calgary; Critical Care Strategic Clinical Network (Krewulak, Sept, Stelfox, Fiest), Alberta Health Services, Calgary, Alta.; Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center (Ely) and Critical Illness, Brain Dysfunction, and Survivorship Center (Ely), Vanderbilt University Medical Center, Nashville, Tenn.; Department of Education, Development and Research (Davidson), University of California, San Diego Health, San Diego, Calif
| | - E W Ely
- Departments of Critical Care Medicine (Krewulak, Sept, Stelfox, Fiest), Community Health Sciences (Stelfox, Ismail, Fiest) and Psychiatry (Ismail), O'Brien Institute for Public Health (Stelfox, Ismail, Fiest) and Hotchkiss Brain Institute (Ismail), Cumming School of Medicine, University of Calgary; Critical Care Strategic Clinical Network (Krewulak, Sept, Stelfox, Fiest), Alberta Health Services, Calgary, Alta.; Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center (Ely) and Critical Illness, Brain Dysfunction, and Survivorship Center (Ely), Vanderbilt University Medical Center, Nashville, Tenn.; Department of Education, Development and Research (Davidson), University of California, San Diego Health, San Diego, Calif
| | - Judy E Davidson
- Departments of Critical Care Medicine (Krewulak, Sept, Stelfox, Fiest), Community Health Sciences (Stelfox, Ismail, Fiest) and Psychiatry (Ismail), O'Brien Institute for Public Health (Stelfox, Ismail, Fiest) and Hotchkiss Brain Institute (Ismail), Cumming School of Medicine, University of Calgary; Critical Care Strategic Clinical Network (Krewulak, Sept, Stelfox, Fiest), Alberta Health Services, Calgary, Alta.; Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center (Ely) and Critical Illness, Brain Dysfunction, and Survivorship Center (Ely), Vanderbilt University Medical Center, Nashville, Tenn.; Department of Education, Development and Research (Davidson), University of California, San Diego Health, San Diego, Calif
| | - Zahinoor Ismail
- Departments of Critical Care Medicine (Krewulak, Sept, Stelfox, Fiest), Community Health Sciences (Stelfox, Ismail, Fiest) and Psychiatry (Ismail), O'Brien Institute for Public Health (Stelfox, Ismail, Fiest) and Hotchkiss Brain Institute (Ismail), Cumming School of Medicine, University of Calgary; Critical Care Strategic Clinical Network (Krewulak, Sept, Stelfox, Fiest), Alberta Health Services, Calgary, Alta.; Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center (Ely) and Critical Illness, Brain Dysfunction, and Survivorship Center (Ely), Vanderbilt University Medical Center, Nashville, Tenn.; Department of Education, Development and Research (Davidson), University of California, San Diego Health, San Diego, Calif
| | - Kirsten M Fiest
- Departments of Critical Care Medicine (Krewulak, Sept, Stelfox, Fiest), Community Health Sciences (Stelfox, Ismail, Fiest) and Psychiatry (Ismail), O'Brien Institute for Public Health (Stelfox, Ismail, Fiest) and Hotchkiss Brain Institute (Ismail), Cumming School of Medicine, University of Calgary; Critical Care Strategic Clinical Network (Krewulak, Sept, Stelfox, Fiest), Alberta Health Services, Calgary, Alta.; Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center (Ely) and Critical Illness, Brain Dysfunction, and Survivorship Center (Ely), Vanderbilt University Medical Center, Nashville, Tenn.; Department of Education, Development and Research (Davidson), University of California, San Diego Health, San Diego, Calif.
| |
Collapse
|
20
|
Aya AGM, Pouchain PH, Thomas H, Ripart J, Cuvillon P. Incidence of postoperative delirium in elderly ambulatory patients: A prospective evaluation using the FAM-CAM instrument. J Clin Anesth 2018; 53:35-38. [PMID: 30292069 DOI: 10.1016/j.jclinane.2018.09.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 09/07/2018] [Accepted: 09/29/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND While the incidence of postoperative delirium is high in aged hospitalized patients undergoing major surgery, little is known concerning patients undergoing ambulatory surgery. OBJECTIVE To determine the incidence of postoperative delirium in aged patients after hospital discharge from an ambulatory surgery unit. DESIGN Prospective observational study. PATIENTS Elderly patients (≥75 years) scheduled for a surgical procedure on an ambulatory basis. INTERVENTIONS Filling of the Family Confusion Assessment Method (FAM-CAM) questionnaire (11 items) during a phone interview of family caregivers on two separate occasions: five to three days before surgery, and three to five days after surgery. MAIN OUTCOME MEASURES The detection of acute onset and fluctuating course inattention, disorganized thinking, altered level of consciousness, disorientation, perceptual disturbances, and psychomotor agitation from the observations of family caregivers. RESULTS Signs of delirium appeared de novo in 2 of 141 patients (incidence 1.4%) in the postoperative period: a 80-years old man who was disoriented and had incoherent and illogical speech on postoperative day 1 of resection of a cephalic cutaneous melanoma under local anesthesia and sedation (midazolam, sufentanil, and propofol), and a 83-years old woman with a pre-existing mental confusion, who experienced visual and hearing hallucinations and had inappropriate behaviour on postoperative day 2 of cataract surgery performed under episcleral block. Both patients returned to their preoperative states within a few days. CONCLUSIONS Using the FAM-CAM instrument for the detection of postoperative delirium in ambulatory patients, the study showed that the incidence of cognitive changes in the ambulatory setting is very low. Among several putative factors, the lightness of the surgical procedure, the wide use of regional anesthesia, and the short hospital stay may be contributing factors to this result. The findings of this study need to be confirmed in a larger sample of patients.
Collapse
Affiliation(s)
- Antoine G M Aya
- New Bonnefon Clinic, Alès, France; Nîmes University Hospital, Nîmes, France.
| | | | | | | | | |
Collapse
|