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Avelino-Silva TJ, Bittencourt JAS, Miguel CG, Rozzino TPDC, Vaccari AMH, Barbosa MS, Szlejf C. The Confusion Assessment Method in action: Implementation of a protocol to increase delirium screening and diagnosis. Geriatr Nurs 2023; 54:32-36. [PMID: 37703687 DOI: 10.1016/j.gerinurse.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023]
Abstract
The use of the Confusion Assessment Method (CAM) for delirium assessment in real-life can be inconsistent. We examined the impact of a protocol on delirium screening and detection in hospitalized older adults using the CAM. We analyzed data from 32,338 admissions to a quaternary hospital between 2018 and 2022. We assessed the percentage of admissions screened for delirium, adherence to daily screening, positive screening, and overlap with ICD-10 coding. The percentage of admissions screened for delirium increased from 74% in 2018 to 98.7% in 2022. Adherence to daily screening was achieved in 24.5% of admissions, and the percentage of positive screenings fluctuated between 8.4% and 11.5%. Among the admissions with a delirium-related ICD-10 code, 32% had a positive screening, 62% were negative, and 6% remained unscreened. While implementing a protocol increased the proportion of admissions screened for delirium, adherence to daily screening and consistency of positive delirium screenings remain areas for improvement.
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Affiliation(s)
- Thiago Junqueira Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento, Serviço de Geriatria, Departamento de Clínica Médica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina da Universidade de Sao Paulo. Av. Dr. Enéas Carvalho de Aguiar 155, Prédio dos Ambulatórios, 8° Andar, Setor Azul, LIM-66, São Paulo, SP, 05304-000, Brazil; Global Brain Health Institute, University of California San Francisco. Attention: GBHI Memory and Aging Center, MC: 1207 1651 4th St, 3rd Floor, San Francisco, CA 94143, USA
| | - José Adenaldo Santos Bittencourt
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil
| | - César Gomes Miguel
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil
| | - Tatianna Pinheiro da Costa Rozzino
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil
| | - Andreia Maria Heins Vaccari
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil
| | - Michelle Simone Barbosa
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil
| | - Claudia Szlejf
- Hospital Israelita Albert Einstein, Departamento de Big Data & Analytics, Rua Comendador Elias Jafet, 755, Piso 1, sala 134, CEP: 05653-000, Sao Paulo, SP, Brazil.
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Zangl Q, Kaiser A, Iglseder B. Psychotherapy: A tool to prevent postoperative delirium? J Perioper Pract 2023; 33:48-52. [PMID: 35225713 DOI: 10.1177/17504589211059333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The value of psychotherapy in surgical patients suffering from postoperative delirium is unclear. Options for the treatment of established postoperative delirium are few; therapy largely relies on the avoidance of postoperative delirium facilitating factors, like specific drugs and environmental factors in the perioperative setting. Established medical therapies' efficacy in terms of decreasing incidence of postoperative delirium is very low. The aim of this project is to suggest new therapeutic options in the form of cognitive behavioural therapy as a possible preventive and psychotherapeutic treatment of postoperative delirium. Life expectancy in developed countries increases worldwide and both the need for surgical treatment and the probability of postoperative delirium occurrence increase with age. Due to the necessity of addressing the individual's negative consequences of postoperative delirium and to optimise socioeconomical needs, new therapeutic options for the treatment of postoperative delirium are desperately needed.
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Affiliation(s)
- Quirin Zangl
- Department of Neuroanesthesia, Christian Doppler Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Kaiser
- Department of Clinical Psychology, Christian Doppler Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatrics, Christian Doppler Hospital, Paracelsus Medical University, Salzburg, Austria
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Salma I, Waelli M. Mapping research findings on change implementation in nursing practice: A scoping literature review. Nurs Open 2022; 10:450-468. [PMID: 36112719 PMCID: PMC9834520 DOI: 10.1002/nop2.1369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/20/2022] [Accepted: 08/30/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS The aim of this study was to map the diverse factors impacting change implementation in nursing practices and investigate different implementation strategies. DESIGN Scoping literature review following PRISMA-ScR extension. METHODS Data were collected from PubMed, Ebsco, Scopus and ScienceDirect databases from 1990 onwards. Only English peer-reviewed studies reporting an implementation of change in nursing practice were included. Of 9,954 studies, 425 abstracts were scanned and 98 full-text articles were screened. Finally, 28 studies were selected. RESULTS A multifaceted approach, with a tailored intervention, was the most effective implementation strategy. Most identified factors were considered systematic, for example resource availability, leadership and knowledge. However, others related to local social and material context were identified in fewer number of studies. These seem to be operational elements for implementation processes. Both types of factors are essential and must be considered for successful implementation. CONCLUSION We advocate the development of framework including systematic factors and which capture the local context flexibility.
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Affiliation(s)
- Israa Salma
- École des Hautes Etudes en Santé PubliqueInserm U 1309‐RSMS, CNRS UMR 6051 ‐ ARENESRennesFrance
| | - Mathias Waelli
- École des Hautes Etudes en Santé PubliqueInserm U 1309‐RSMS, CNRS UMR 6051 ‐ ARENESRennesFrance,Global Health InstituteGeneva UniversityGeneveSwitzerland
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Kim JH, Hua M, Whittington RA, Lee J, Liu C, Ta CN, Marcantonio ER, Goldberg TE, Weng C. A machine learning approach to identifying delirium from electronic health records. JAMIA Open 2022; 5:ooac042. [PMID: 35663114 PMCID: PMC9152701 DOI: 10.1093/jamiaopen/ooac042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/01/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
The identification of delirium in electronic health records (EHRs) remains difficult due to inadequate assessment or under-documentation. The purpose of this research is to present a classification model that identifies delirium using retrospective EHR data. Delirium was confirmed with the Confusion Assessment Method for the Intensive Care Unit. Age, sex, Elixhauser comorbidity index, drug exposures, and diagnoses were used as features. The model was developed based on the Columbia University Irving Medical Center EHR data and further validated with the Medical Information Mart for Intensive Care III dataset. Seventy-six patients from Surgical/Cardiothoracic ICU were included in the model. The logistic regression model achieved the best performance in identifying delirium; mean AUC of 0.874 ± 0.033. The mean positive predictive value of the logistic regression model was 0.80. The model promises to identify delirium cases with EHR data, thereby enable a sustainable infrastructure to build a retrospective cohort of delirium. Delirium is a commonly observed complication in hospitalized patients, especially with intensive care. While signs and symptoms of delirium could be observed and well managed during the hospital stay, less is known about the long-term complication of delirium after discharge. In order to monitor the long-term sequelae of delirium, the correct identification of delirium patients is crucial. Currently, the retrospective identification of delirium patients is limited due to the under-coding of delirium diagnosis in electronic health records. We proposed a simple machine-learning model to retrospectively identify patients who experienced delirium during their intensive care unit stay. The model could be used to identify missed delirium cases and the establishment of a delirium cohort for long-term monitoring and surveillance.
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Affiliation(s)
- Jae Hyun Kim
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - May Hua
- Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Robert A Whittington
- Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Junghwan Lee
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Cong Liu
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Casey N Ta
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Edward R Marcantonio
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Terry E Goldberg
- Department of Anesthesiology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
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Hut-Mossel L, Ahaus K, Welker G, Gans R. Understanding how and why audits work in improving the quality of hospital care: A systematic realist review. PLoS One 2021; 16:e0248677. [PMID: 33788894 PMCID: PMC8011742 DOI: 10.1371/journal.pone.0248677] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Several types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care. METHODS A realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context-mechanism-outcome configurations (CMOcs). RESULTS From our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration. CONCLUSIONS This realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts. PROSPERO REGISTRATION CRD42016039882.
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Affiliation(s)
- Lisanne Hut-Mossel
- Centre of Expertise on Quality and Safety, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Kees Ahaus
- Department Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Gera Welker
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rijk Gans
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Lieow JLM, Chen FSM, Song G, Tang PS, Kowitlawakul Y, Mukhopadhyay A. Effectiveness of an advanced practice nurse-led delirium education and training programme. Int Nurs Rev 2019; 66:506-513. [PMID: 31066049 DOI: 10.1111/inr.12519] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM To develop an education and training programme to enhance bedside nurses' knowledge, competency and compliance in accurately performing delirium screening in intensive care units. BACKGROUND Delirium in intensive care units is associated with several poor patient outcomes. Delirium detection can be improved by enhancing nurses' knowledge, competency and compliance in accurately performing delirium screening. METHODS A descriptive quantitative study with pretest-post-test design was adopted. There were 245 nurses from five intensive care units who participated in the study. Multiple-choice questions were used to assess nurses' knowledge change before and after the education programme. Competency was assessed before and 2 months after the programme by simulation with a standardized patient, followed by real patients at the bedside. Compliance data on screening were collected from the documentation of the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the ICU before and 3 and 10 months after the programme. Data collection took 1 year, from June 2014 to May 2015. RESULTS Despite nurses' improved knowledge and good competency, delirium screening documentations after 3 months were poor. However, screening documentations subsequently improved when measured at 10 months, following further emphasis by the senior nursing staff. IMPLICATIONS FOR NURSING PRACTICE AND POLICY Nursing administrators and bedside nurses need to be involved in the policy-making process and plan a training programme for the new nursing staff in the high-risk areas. A short refreshment course should be offered to the nursing staff 3 months after the initial training programme. CONCLUSIONS Improved knowledge and competency in assessment did not improve compliance and documentation of delirium screening. Therefore, it is important to reinforce nurses' compliance of delirium screening over time.
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Affiliation(s)
- J L M Lieow
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University of Singapore, Singapore City, Singapore
| | - F S M Chen
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University of Singapore, Singapore City, Singapore
| | - G Song
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University of Singapore, Singapore City, Singapore
| | - P S Tang
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University of Singapore, Singapore City, Singapore
| | - Y Kowitlawakul
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - A Mukhopadhyay
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University of Singapore, Singapore City, Singapore
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Trapani J, Walker W. What's in this Issue. Nurs Crit Care 2018; 23:167-168. [PMID: 30134033 DOI: 10.1111/nicc.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Josef Trapani
- Lecturer in Nursing, Editorial Intern, Nursing in Critical Care
| | - Wendy Walker
- Reader in Acute and Critical Care Nursing, Editorial Intern, Nursing in Critical Care
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