ED‐DEL: Development of a change package and toolkit for delirium in the emergency department

Abstract

Delirium is a common and deadly problem in the emergency department affecting up to 30% of older adult patients. The 2013 Geriatric Emergency Department guidelines were developed to address the unique needs of the growing older population and identified delirium as a high priority area. The emergency department (ED) environment presents unique challenges for the identification and management of delirium, including patient crowding, time pressures, competing priorities, variable patient acuity, and limitations in available patient information. Accordingly, protocols developed for inpatient units may not be appropriate for use in the ED setting. We created a Delirium Change Package and Toolkit in the Emergency Department (ED-DEL) to provide protocols and guidance for implementing a delirium program in the ED setting. This article describes the multistep process by which the ED-DEL program was created and the key components of the program. Our ultimate goal is to create a resource that can be disseminated widely and used to improve delirium identification, prevention, and management in older adults in the ED.

Emergency Clinicians’ Perceptions of Communication Tools to Establish the Mental Baseline of Older Adults: A Qualitative Study

“…In this qualitative study, the majority of emergency clinicians viewed documents and videos depicting a patient's baseline mental status as useful adjuncts in evaluating older adults with altered mental status. The development and use of document-or video-based communication tools could have important implications for improving the detection of delirium, which goes undetected in at least two-thirds of ED cases [7,9]. To our knowledge, pre-recorded video of a patient has not previously been used to help clinicians identify delirium or dementia; this novel and pioneering approach could be promising given the recent rapid expansion and increased acceptability of telemedicine and video-based care during the COVID-19 pandemic [22].…”

“…Participants' emphasis on brevity as an essential feature of any communication tool reflects emergency clinicians' time constraints and competing priorities when evaluating older adults [3,7,9]. In light of such challenges, the Geriatric Emergency Applied Research Network recommends that delirium detection measures should ideally not create significant time demands for emergency clinicians and nurses [7].…”

“…Delirium, a syndrome of disturbance in consciousness and attention which may be provoked by acute illness, is undetected in at least two-thirds of ED cases [1,5,6]. When detected in the ED, delirium is associated with prolonged hospitalization, falls, and increased mortality [7][8][9]. Cognitive impairment, or difficulty with memory and executive functioning, is similarly underrecognized in EDs [1,10].…”

“…Improving emergency clinicians' ability to evaluate changes in mental status could increase detection of delirium, with potential downstream effects on preventing associated adverse outcomes, both of which are priority areas in geriatric emergency medicine [7,9,11].…”

Balancing vision with pragmatism: The geriatric emergency department guidelines‐realistic expectations from emergency medicine and geriatric medicine

“…21 Developing key outcome measures for effective and sustainable delirium quality improvement will require local physicians and nurse champions to ensure all staff are educated and aligned with similar goals along with institutional support for ongoing efforts. 22 Perhaps the highest priority challenge for delirium experts is to evaluate and publish effective delirium intervention strategies since current evidence is completely lacking for ED-based delirium prevention or treatment. 23,24 ED FALL PATIENT Thirty per-cent of adults over 65 years who live in the community fall each year.…”