Abstract
Delirium is prevalent, costly, and morbid, yet underdetected by clinicians. We tested feasibility and acceptability of a 2-step delirium identification protocol. Step 1, a screener, consists of “What is the day of the week?” and “Months of the year backwards.” If either/both items are incorrect, step 2, a 3-minute diagnostic assessment (3D-CAM) follows. Trained researchers enrolled 23 older hospitalized adults and identified 22% to be delirious after a reference standard assessment. Thereafter, physicians, and nurses, completed the 2-step protocol, while certified nursing assistants (CNAs) completed the screener only, all on the same patients. The screener took a median of 36 seconds to administer, with sensitivities: nurses-100%, CNA’s-100%, physicians-80%. The 2-step protocol achieved sensitivities: nurses- 100%, physicians-80%, and specificities: nurses-89%, physicians-78%. Barriers and facilitators to implementation were also collected. We conclude that our screener and 2-step protocol can be feasibly implemented by clinicians, and is a promising approach to improve delirium identification.
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