Implementing Delirium Screening in the ED

Implementing delirium screening in the emergency department can be challenging.  Several tips can improve the success of any delirium screening implementation program

Improving a delirium screening in the ED must be a collaborative effort involving ED healthcare providers of all disciplines such as nurses, physicians, nurse practitioners, physician’s assistants, pharmacists, or patient care technicians or certified nurse assistants.  This interdisciplinary team would choose the optimal delirium assessment, provide education to their respective disciplines, and help identify and address potential barriers.

Have delirium champions who will be the “boots on the ground” resource throughout the implementation process.  They will facilitate getting the ED healthcare providers to buy-in to delirium screening.  They will also be available to answer any questions, provide feedback, provide encouragement, and help solve problems when they arise.

Integrating a delirium assessment into the electronic health record will facilitate uptake.  Such integration could prompt the healthcare provider to perform a delirium assessment (e.g., patients who are 65 years of age).  Instructions on how to perform a delirium assessment or its components could also be embedded into the electronic health record.  The rating or scoring of the delirium assessment (e.g., positive or negative CAM) could also be automated.

If delirium screening does not lead to an action, then its implementation is unlikely to succeed.  For example, a positive delirium screen could trigger a diagnostic bundle or clinical care pathway.  A negative delirium screen could trigger delirium prevention strategies for high-risk patients.