Implementation of delirium screening in the emergency department: A qualitative study with early adopters.
delirium
emergency department
implementation science
qualitative
screening
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
12 Sep 2024
12 Sep 2024
Historique:
revised:
26
07
2024
received:
17
06
2024
accepted:
04
08
2024
medline:
12
9
2024
pubmed:
12
9
2024
entrez:
12
9
2024
Statut:
aheadofprint
Résumé
Delirium 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. We 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. Overall, 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. Implementing ED delirium screening is complex and requires institutional resources as well as clinical champions to engage frontline staff in a sustained fashion.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Society for Academic Emergency Medicine Foundation (GEMSSTAR Supplement Award)
Organisme : Houston Veterans Administration Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety
ID : CIN13-413
Organisme : NIA NIH HHS
ID : R03AG078943
Pays : United States
Organisme : NIA NIH HHS
ID : R61AG069822
Pays : United States
Organisme : Baylor College of Medicine (Chao Physician-Scientist Award, Curtis Hankamer Basic Research Award)
Informations de copyright
© 2024 The American Geriatrics Society.
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