Implementation of delirium screening in the emergency department: A qualitative study with early adopters

IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY
Anita N. Chary, Annika R. Bhananker, Elise Brickhouse, Beatrice Torres, Ilianna Santangelo, Kyler M. Godwin, Aanand D. Naik, Christopher R. Carpenter, Shan W. Liu, Maura Kennedy
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Abstract

IntroductionDelirium affects 15% of older adults presenting to emergency departments (EDs) but is detected in only one‐third of cases. Evidence‐based guidelines for ED delirium screening exist, but are underutilized. Frontline staff perceptions about delirium and time and resource constraints are known barriers to ED delirium screening uptake. Early adopters of ED delirium screening can offer valuable lessons about successful implementation.MethodsWe conducted semi‐structured interviews with clinician‐administrators leading ED delirium screening initiatives from 20 EDs in the United States and Canada. Interviews focused on experiences of planning and implementing ED delirium screening. Interviews lasted 15 to 50 minutes and were digitally recorded and transcribed. To identify factors that commonly impacted implementation of ED delirium screening, we used constructs from the Consolidated Framework for Implementation Research (CFIR), an Implementation Science framework widely used to evaluate healthcare improvement initiatives.ResultsOverall, notable facilitators of successful implementation were having institutional and ED leadership support and designated clinical champions to longitudinally engage and educate frontline staff. We found specific examples of factors affecting implementation drawn from the following seven CFIR constructs: (1) intervention complexity, (2) intervention adaptability, (3) external policies and incentives, (4) peer pressure from other institutions, (5) the implementation climate of the ED, (6) staff knowledge and beliefs, and (7) engaging deliverers of intervention, that is, frontline ED staff.ConclusionImplementing ED delirium screening is complex and requires institutional resources as well as clinical champions to engage frontline staff in a sustained fashion.
在急诊科实施谵妄筛查:对早期采用者的定性研究
导言:在急诊科(ED)就诊的老年人中,15%患有谵妄,但只有三分之一的病例能被发现。目前已有基于证据的急诊科谵妄筛查指南,但未得到充分利用。一线工作人员对谵妄的认识以及时间和资源的限制是阻碍急诊科接受谵妄筛查的已知障碍。我们对来自美国和加拿大 20 家急诊室的急诊室谵妄筛查项目负责人进行了半结构化访谈。访谈的重点是计划和实施急诊室谵妄筛查的经验。访谈持续了 15 到 50 分钟,并进行了数字录音和转录。为了确定通常影响急诊室谵妄筛查实施的因素,我们使用了实施研究综合框架(CFIR)中的构架,该框架是一个实施科学框架,被广泛用于评估医疗保健改进措施。结果总的来说,成功实施的显著促进因素是得到机构和急诊室领导的支持,以及指定临床倡导者纵向参与和教育一线员工。我们从以下七个 CFIR 构架中找到了影响实施因素的具体实例:(1)干预的复杂性,(2)干预的适应性,(3)外部政策和激励机制,(4)来自其他机构的同行压力,(5)急诊室的实施氛围,(6)员工的知识和信念,以及(7)干预实施者(即急诊室一线员工)的参与。
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来源期刊
CiteScore
10.00
自引率
6.30%
发文量
504
审稿时长
3-6 weeks
期刊介绍: Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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