In hospitalized older adult patients (P) , how does identification of delirium (I) compared to not identifying (C) affect prevention or management of deliriu

PICOT Statement

State your PICOT statement from Week 2 in the standard format and label each element ( e.g., P, I, C, O, T).

In hospitalized older adult patients (P) , how does identification of delirium (I) compared to not identifying (C) affect prevention or management of delirium and its effect (O) within 3 month’s time (T)?

Original Research Articles

Full reference for article (APA Format) and Chamberlain University hyperlink

Oliven, R., Rotfeld, M., Gino-Moor, S., Schiff, E., Odeh, M., & Gil, E. (2021). Early Detection and Intervention for Patients with Delirium Admitted to the Department of Internal Medicine: Lessons from a Pilot Initiative. Dementia and Geriatric Cognitive Disorders Extra, 11(2), 134–139. https://doi.org/10.1159/000515958

Link: https://chamberlain.primo.exlibrisgroup.com/discovery/search?vid=01CUCON_INST:DEFAULT&tab=Everything&search_scope=MyInst_and_CI&lang=en&query=any,contains,Early%20Detection%20and%20Intervention%20for%20Patients%20with%20Delirium%20Admitted%20to%20the%20Department%20of%20Internal%20Medicine:%20Lessons%20from%20a%20Pilot%20Initiative.%20Dementia%20and%20geriatric%20cognitive%20disorders%20extra

Purpose and Type of Research

The article aims to assess the effectiveness of early detection and management strategies for delirium through tools such as the 4AT assessment and early mobilization protocols. This study would, therefore, seek to enhance patient outcomes through the proactive handling of delirium. The research is an original research article in that it reports findings from a pilot initiative implemented in the internal medicine department of a hospital. It does not test a theoretical framework but investigates practical applications of delirium detection and management.

Methods

Methods

This was a pilot initiative that consisted of a study design using the implementation of the 4AT tool for screening for delirium and introducing structured early mobilization as an intervention. Feasibility data for the above practices were collected regarding the impact on patients admitted to the internal medicine department. Changes in the incidence of delirium were recorded, with observed effectiveness of strategies documented via observational data and outcome monitoring.

Sample and Participants

The study involved patients admitted to the Department of Internal Medicine in one health facility. Participants targeted were adults who were at risk of developing delirium, although specific criteria for inclusion and exclusion were not stated. The sample size was small, as this initiative was a pilot to try the feasibility and effectiveness of interventions within a controlled scope.

Study Findings

These results showed that the use of the 4AT as a screening tool for early detection of delirium and structured early mobilization could reduce the severity and duration of the condition. The feasibility of these strategies in routine clinical practice to improve patient outcomes was evident in this pilot initiative. Moreover, the study pointed out the importance of a multidisciplinary approach in managing delirium.

Limitations of the Study

Limitations to the study were multiple and largely related to its pilot nature. The sample size was small, limiting the generalizability of the findings. It was conducted in a single healthcare setting, reducing the applicability of results across diverse populations or facilities. In addition, there was no control group for this study, which can be considered a limitation since outcomes could not be wholly attributed to the interventions being tested.

Relevance to Practice Issue or Proposed Intervention

The study is highly pertinent to this practice issue of improving patient outcomes for those at risk of delirium through timely detection and intervention. This is especially important in hospitalized patients, where delirium has been shown to be associated with worse outcomes, such as prolonged hospital stay, increased mortality, and long-term cognitive decline. It has provided evidence-based, practical approaches that will fit easily into routine care by demonstrating the feasibility and efficacy of the 4AT screening tool and structured early mobilization protocols. This finding informs action on current interventions that will result in proactive management of delirium and complements goals of increasing patient safety with decreasing complication rates and improving overall quality of care. The finding also has implications for collaborative interaction in multidisciplinary teamwork for the actualization of such interventions, thus becoming more relevant in clinical settings for resource optimization and patient-centered care.

Original Research Articles

Full reference for article (APA Format) and Chamberlain University hyperlink

Meged-Book, T., Frenkel, R., Nikonov, A., Zeldetz, V., Kosto, A., Schwarzfuchs, D., Freud, T., & Press, Y. (2024). Delirium screening in the emergency department: evaluation and intervention. Israel Journal of Health Policy Research, 13(1), 16–19. https://doi.org/10.1186/s13584-024-00603-1

Link: https://chamberlain.primo.exlibrisgroup.com/discovery/search?query=any,contains,Delirium%20screening%20in%20the%20emergency%20department:%20evaluation%20and%20intervention&tab=Everything&search_scope=MyInst_and_CI&vid=01CUCON_INST:DEFAULT&lang=en&offset=0

Purpose and Type of Research

This study aimed to assess the effectiveness of a delirium screening conducted in the ED, where the main focus was on investigating the effectiveness of a specific delirium screening protocol in which there was a dedicated evaluator. The current study prospectively compared the outcomes for screened and unscreened patients, with a special focus on the recognition of delirium and related factors like age, comorbidities, and living status. This is a quantitative, observational study aimed at determining the prevalence of delirium among elderly patients in the ED and the effectiveness of interventions to improve diagnosis.

Methods

This was a pre-and post-intervention study; data collection occurred in two phases. The initial period, T1, consisted of raising awareness about delirium among ED staff. In the second phase, T2, active screening was conducted by a delirium evaluator. The main outcomes measured included the rate of delirium diagnosis, rates of hospitalization, and the influence of various patient factors on diagnosis. Delirium screening was done by utilizing tools such as the 4AT delirium assessment tool; data was gathered from direct observations and clinical assessments of the patient and the patient's medical records.

Sample and Participants

The sample size was 5,174 patients; of those, 451 patients were screened for delirium in the second phase, 780 were admitted without a delirium evaluator, and 4,943 were unscreened. The mean age of the participants was 77.6 years, and 51.9% of the patients were female. This is an older adult population in which most of the sample had comorbid conditions that could affect the presence of delirium.

Study Findings

Out of the patients screened, delirium was diagnosed in 14.9%, while only 1.9% were diagnosed when compared to those not screened in the absence of delirium evaluators. The diagnosis was significantly higher in the screened population, which showed that having a dedicated delirium evaluator enhanced the identification of that condition. Additionally, patients diagnosed with delirium were older, had higher rates of comorbidities (demented especially), and were more likely to be admitted to a hospital. This study established that moreover delirium was associated with those cases reported higher rates of confusion by ED staff, lower family status, and a higher Charlson comorbidity score. There were also significant differences in vital signs between these patients like abnormal temperatures, blood pressures, and oxygen saturations, all indicating higher instability clinically. The findings indicated the importance of screening for delirium in achieving better diagnoses and treatment outcomes in the ED.

Limitations of the Study

Several limitations were declared in the study. First, only 36.6% of eligible patients were screened, with no rationale provided for exclusions, which may be subject to selection bias. Secondly, the Charlson Comorbidity Index is used to assess comorbidities without accounting for the individual conditions' severity, which might affect the risk of developing delirium. Another limitation was the lack of post-hospitalization follow-up, meaning the study could not track the resolution of delirium or long-term outcomes such as mortality beyond 90 days. Finally, the focus of the study on the immediate impact of the delirium screening interventions did not address the long-term sustainability of improvements in the recognition of delirium.

Relevance to Practice Issue or Proposed Intervention

The results of this study are very relevant to clinical practice, especially in enhancing the management of delirium in the ED. This study emphasizes the implementation of compulsory delirium screening at triage for older adults since early diagnosis is vital in minimizing the morbidity and mortality rates related to delirium. Given the high impact of delirium on patient outcomes, this study recommends the integration of delirium screening into routine triage for all patients aged 65 years and above. It is also suggested that electronic medical record alerts and automated screening tools be adopted; these interventions may lead to earlier recognition and, thus earlier management of delirium, improving patient outcomes. The study adds weight to the fact that only such systematic approaches, including compulsory screening and electronic reminders, will help to improve the detection and management of delirium in ED.

Synthesis Articles

Full reference for article (APA Format)

Tieges, Z., Maclullich, A. M. J., Anand, A., Brookes, C., Cassarino, M., O’connor, M., Ryan, D., Saller, T., Arora, R. C., Chang, Y., Agarwal, K., Taffet, G., Quinn, T., Shenkin, S. D., & Galvin, R. (2021). Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis. Age and Ageing, 50(3), 733–743. https://doi.org/10.1093/ageing/afaa224

Link: https://chamberlain.primo.exlibrisgroup.com/discovery/search?query=any,contains,Diagnostic%20accuracy%20of%20the%204AT%20for%20delirium:%20A%20systematic%20review%20and%20meta-analysis&tab=Everything&search_scope=MyInst_and_CI&vid=01CUCON_INST:DEFAULT&lang=en&offset=0

Purpose and Type of Research

This systematic review and meta-analysis aimed to determine the diagnostic accuracy of the 4AT tool for detecting delirium among older patients in various clinical settings. Delirium is a common condition among the elderly that, despite its high morbidity and mortality, often goes undiagnosed. The study seems to ascertain whether the 4AT represents an effective brief delirium screening tool in the diagnosis of delirium and inform clinical practice. This study is diagnostic in nature and is focused on assessing the accuracy of a particular clinical tool.

Search strategy

They carried out a systematic search through the four major databases: PubMed, Web of Science, PsycINFO, and EMBASE. Such data include studies published from inception until April 2020 and updated in January 2022. Keywords related to delirium and the 4AT screening tool were used. Lastly, relevant systematic reviews and meta-analyses were reviewed to see whether there were any additional studies meeting the inclusion criteria. The search strategy adhered to the PRISMA guidelines.

Discussion of Inclusion Criteria

Thus, the studies that were included in this review were those that met some criteria. They included studies that examined the use of the 4AT for delirium detection in adult patients of 18 years and over. They needed to provide diagnostic accuracy data for the 4AT, such as sensitivity, specificity, and so on. They had to be published in peer-reviewed journals in English, focusing on environments where there is a higher prevalence of delirium in older adults, such as hospitals, emergency departments, and intensive care units.

Study Findings

This meta-analysis includes studies in which a total of 2,789 persons were involved. The pooled sensitivity of the 4AT was 0.87, and its pooled specificity was also found to be 0.87, meaning that the instrument is excellent for diagnosing delirium. With a positive likelihood ratio of 6.66, the positive 4AT result indicates a high chance of having acquired delirium, while the negative likelihood ratio of 0.15 implies that a not positive result clearly rules out the diagnosis. Furthermore, the study indicated that variables like patient selection, clinical setting, and timing affect the accuracy of the 4AT tool.

Limitations of the Study

This meta-analysis has a number of limitations. Firstly, while this may be a large sample size, the studies differ in terms of clinical settings and patients under study, which may affect the applicability of findings. Apart from that, the 4AT tool's performance may differ in accordance with the definition and diagnosis of delirium in individual settings. Another limitation of this analysis was to include published studies that may pose a risk of introducing publication bias. Furthermore, the studies did not evaluate the long-term outcomes of delirium diagnosis, using the 4AT, on patient prognosis or healthcare costs.

Relevance to Practice Issue or Proposed Intervention

The results of this study are very relevant to clinical practice, especially for healthcare professionals working with older patients. It has an easy and fast method of screening for delirium, hence very applicable, especially in the time-constrained setting of an ED or even an ICU. Since many cases of delirium are not recognized clinically, this may lead to earlier identification and treatment using the 4AT. This can lead to improvements in patient outcomes by potentially avoiding complications related to the course of delirium. Additionally, the ease of use of the tool and the very minimal training required make it accessible to a broad range of healthcare providers. This study supports the wider use of the 4AT tool in routine clinical practice for the early detection and management of del

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