Identifying Implementation Strategies for Emergency Department (ED) Delirium Screening in Older Adults

确定老年人急诊科 (ED) 谵妄筛查的实施策略

• 批准号: 10704121
• 负责人: ANITA CHARY
• 金额: $ 16万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704121
• 关键词: Accident and Emergency department; Accreditation; Acute; Admission activity; Adopted; Adoption; Affect; Anthropology; Award; Brain; Caring; Characteristics; Code; Complex; Consolidated Framework for Implementation Research; Crowding; Data; Data Set; Decision Making; Delirium; Detection; Development; Elderly; Emergency Care; Emergency Medicine; Emergency department crowding; Emergency department visit; Environment; Ethnography; Evaluation; Failure; Future; Geriatrics; Goals; Health; Health Care Costs; Hospitalization; Human; Human Resources; Immersion; Impaired cognition; Individual; Injury; Inpatients; Institution; Interview; K-Series Research Career Programs; Leadership; Maps; Mentorship; Methods; Minority; Mission; Morbidity - disease rate; Motivation; National Institute on Aging; Nurses; Outcome; Patient Care; Patients; Pattern; Physicians; Prevention; Prevention Protocols; Process; Public Health; Qualitative Methods; Research; Resources; Sampling; Screening procedure; Site; Syndrome; Techniques; Time; Training; Transcript; Treatment Protocols; United States; United States National Institutes of Health; Validation; Visit; Work; brain dysfunction; cost; diagnostic accuracy; effectiveness/implementation trial; emergency settings; evidence based guidelines; experience; functional decline; future implementation; health care delivery; implementation context; implementation facilitators; implementation framework; implementation science; implementation strategy; improved; innovation; insight; instrument; mortality; novel; parallel processing; participant observation; pragmatic implementation; routine care; screening; skills; treatment as usual; Accident and Emergency department; Accreditation; Acute; Admission activity; Adopted; Adoption; Affect; Anthropology; Award; Brain; Caring; Characteristics; Code; Complex; Consolidated Framework for Implementation Research; Crowding; Data; Data Set; Decision Making; Delirium; Detection; Development; Elderly; Emergency Care; Emergency Medicine; Emergency department crowding; Emergency department visit; Environment; Ethnography; Evaluation; Failure; Future; Geriatrics; Goals; Health; Health Care Costs; Hospitalization; Human; Human Resources; Immersion; Impaired cognition; Individual; Injury; Inpatients; Institution; Interview; K-Series Research Career Programs; Leadership; Maps; Mentorship; Methods; Minority; Mission; Morbidity - disease rate; Motivation; National Institute on Aging; Nurses; Outcome; Patient Care; Patients; Pattern; Physicians; Prevention; Prevention Protocols; Process; Public Health; Qualitative Methods; Research; Resources; Sampling; Screening procedure; Site; Syndrome; Techniques; Time; Training; Transcript; Treatment Protocols; United States; United States National Institutes of Health; Validation; Visit; Work; brain dysfunction; cost; diagnostic accuracy; effectiveness/implementation trial; emergency settings; evidence based guidelines; experience; functional decline; future implementation; health care delivery; implementation context; implementation facilitators; implementation framework; implementation science; implementation strategy; improved; innovation; insight; instrument; mortality; novel; parallel processing; participant observation; pragmatic implementation; routine care; screening; skills; treatment as usual

PROJECT SUMMARY/ABSTRACT Delirium, or acute brain failure, affects up to 30% of older adults presenting to emergency care and is associated with functional and cognitive decline, increased mortality, and billions of dollars in annual healthcare costs. However, delirium is not detected in two-thirds of emergency department (ED) cases; we and others have found that a minority of EDs (~14-22%) screen older adults for delirium. The ED environment, characterized by high patient volumes, overcrowding, and parallel processing of patients with conditions of varying acuity, can represent a challenging context for implementation of processes such as delirium screening. This proposal uses an implementation science framework to identify strategies for successful implementation of ED delirium screening. The ED is an important site for evaluation of delirium in an older adult’s care trajectory, as early recognition of delirium in the ED may lead to improved prevention and treatment, downstream health outcomes, and reduced costs. The specific aims of this proposal are to: (1) use qualitative interviews with clinicians leading ED delirium screening initiatives across the United States to identify barriers to and facilitators of implementation, and (2) use rapid ethnographic assessment in one urban high-volume ED to identify strategies for successful implementation of delirium screening within routine ED workflows. Together, these aims will generate novel data about a breadth of approaches to ED delirium screening nationwide while also providing granular data about ground-level implementation. This proposal is unique and innovative in its use of implementation science frameworks and anthropological methods, which are well-suited to investigating healthcare delivery processes in complex settings such as EDs. Furthermore, unlike other ED delirium research, which focuses on validation of screening tools, this research will provide urgently needed information about strategies for successful screening implementation. Overall, this work will facilitate our long-term goal of promoting adoption and successful implementation of ED delirium screening broadly in the United States. Practical implementation strategies for ED delirium screening generated from this work will help refine our approach for a subsequent hybrid effectiveness- implementation trial, which will be the subject of the applicant Dr. Chary’s future career development award to the National Institute on Aging.

项目摘要/摘要 del妄或急性脑衰竭，影响到急诊护理的老年人中有30％ 与功能和认知能力下降，死亡率增加以及每年数十亿美元有关 医疗保健费用。但是，在急诊科（ED）案件的三分之二中未发现del妄；我们和 其他人发现，少数ED（〜14-22％）筛查老年人del妄。 ED环境， 其特征是患者量高，人满为患和平行处理患者 不同的敏锐度可以代表实施诸如del妄的过程的挑战背景 筛选。该建议使用实施科学框架来确定成功的策略 ED Delirum筛查的实施。急诊室是评估旧deli妄的重要地点 成人的护理轨迹，作为急诊署在ED中对ir妄的早期认可可能会改善预防和 治疗，下游健康结果和降低成本。 该提案的具体目的是：（1）对领导ED的临床医生进行定性访谈 美国各地的ir妄筛查计划，以确定实施的障碍和促进者， （2）在一个城市高批量中使用快速的民族志评估来确定成功的策略 在常规工作流程中实施ir妄筛选。这些目标在一起将产生小说 有关在全国范围内进行ED Delirium筛查的广泛方法的数据，同时还提供颗粒状数据 关于地面实施。该建议在使用实施科学方面是独特而创新的 框架和人类学方法，非常适合研究医疗保健提供过程 在复杂的设置（例如EDS）中。此外，与其他ED Delirium Research不同，该研究侧重于验证 筛选工具，这项研究将为成功提供有关策略的急需信息 筛选实施。 总体而言，这项工作将有助于我们促进采用和成功实施的长期目标 Ed Delirum筛查在美国广泛。 ED Delirium的实际实施策略 这项工作产生的筛选将有助于完善我们的方法，以实现随后的混合有效性 - 实施审判，这将是Chary博士未来职业发展奖的申请主题 国家老化研究所。