SQiD talks: A qualitative study about starting conversations with the single question in delirium (SQiD)

The Single Question in Delirium (SQiD) is a widely used delirium detection tool utilising discussion between clinicians and informants. This study aims to understand how the SQiD works in clinical settings. Using qualitative methodology, with a grounded theory framework, informant interviews were analysed to understand better how the SQiD works in clinical contexts. Participants were the adult relatives, carers, or friends (informants) of inpatients in an oncology ward at an acute hospital in Sydney, Australia. The informant was an available person whom staff would ordinarily approach for collateral information. The SQiD was administered and recorded by nursing staff. The recording was transcribed verbatim, checked, and then thematically analysed independently by two researchers. Themes/subthemes were determined and discussed until consensus was reached, then reviewed with a third researcher. Patient demographics, including documented diagnosis of delirium, were extracted from their Electronic Medical Record. Of 29 interviews, 15 patients screened positive for delirium, six of whom had a documented diagnosis of delirium. Emergent themes included recognition of “confusion”, operational factors, and the SQiD outcome. The overarching themes were clinician investment and interest in the process, communication techniques, and knowledge of delirium and other cognitive disorders. This study indicates that the SQiD’s usefulness might be enhanced by providing clinicians with specific education about delirium, and differentiation between delirium and other neurocognitive disorders. Moreover, education could be accompanied by measures to encourage clinicians to extend SQiD discussions, act on SQiD findings, and embed the SQiD in clinical practice through implementation strategies. Clinician investment was inconsistent and warrants further investigation.