Comparative salary-related costs of a brief app-directed delirium identification protocol by hospitalists, nurses, and nursing assistants

A narrative review of the development and performance characteristics of electronic delirium-screening tools

BACKGROUND

Electronic delirium-screening tools are an emergent area of research.

OBJECTIVE

The objective of this study was to summarise the development and performance characteristics of electronic screening tools in delirium.

METHODS

Searches were conducted in Pubmed, Embase, and CINAHL Complete databases to identify electronic delirium-screening tools.

RESULTS

Five electronic delirium-screening tools were identified and reviewed. Two were designed for and tested within a medical setting, and three were applied to intensive care. Adaptive design features, such as skip function to reduce test burden, were variably integrated into instrument design. All tools were shown to have acceptable psychometric properties, but validation studies were largely incomplete.

CONCLUSIONS

Electronic delirium-screening tools are an exciting area of development and may offer hope for improved uptake of delirium screening.

Bringing Delirium to Light: Impact of CAM-ICU Tool to Improve Care Coordination

BACKGROUND

Delirium is a serious complication in patients in the critical care unit (CCU) that may lead to prolonged hospitalization if left undetected. The CCU at our hospital does not have a framework for determining delirium that could affect patient outcomes and discharge planning.

PRIMARY PRACTICE SETTING

CCU in a community hospital.

METHOD

A posttest-only design was used for this study. We established a framework for the early assessment of delirium, educated and trained nurses to detect delirium, collaborated with the informatics department, intensivist, nursing, respiratory therapy and worked with case management to deploy the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). We used a one-tailed independent t test to determine the impact of CAM-ICU on length of stay (LOS). Cross-tabulation and chi-square tests were used to examine the impact of CAM-ICU tool on home care utilization between the intervention and comparison groups.

RESULTS

There was a 3.12% reduction in LOS after implementing the CAM-ICU tool. Also, a reduction in home care service utilization demonstrated statistical significance ( p = .001) between the intervention group (62.5%; n = 177) and the comparison group (37.5%; n = 106).

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Case managers are essential in improving care transitions. Case managers need to become competent in understanding the implications of the CAM-ICU tool because of their relevant role in the multidisciplinary rounds as advocates to improve care transitions across the continuum of care. Case managers need to have an understanding on how to escalate when changes in the Richmond Agitation-Sedation Scale scores occur during the multidisciplinary rounds because it can affect care coordination throughout the hospital.

CONCLUSIONS

Implementing the CAM-ICU decreased LOS, and reduced health care utilization. The early identification of patients with delirium can affect the outcomes of critically ill patients and entails multidisciplinary collaboration.

Recognition of Delirium Superimposed on Dementia: Is There an Ideal Tool?

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.

Bibliometric Analysis of 100 Most-Cited Articles in Delirium

Delirium is a cognitive disorder with complex etiology, which brings a great burden to social health care. Articles with high citation frequency can provide important information about the current research situation in a certain field. Web of Science was used to search the 100 most-cited articles and we extracted key information, such as the authors, countries/regions, institutions, journals, and study types of these articles. CiteSpace was used to visually analyze the keywords. Our bibliometric analysis shows that the attention in this field continues to rise. Authors from the United States published the most articles and Inouye SK is the most influential author in the field. The journals that published these articles have high impact factors. Cohort studies are the main cited articles in this field, and there are a large number of systematic reviews or meta-analyses of cohort studies. Risk factors for delirium, psychometric evaluation, hospital care, and various clinical study design are still the focus of research. In short, we summarized the 100 most-cited articles in the field of delirium to identify the current status and global trends. These results enable researchers to understand the quality and trend of research in the field of delirium and make better use of the classical literature.