Department of Physiotherapy, Cork University Hospital, Cork, Ireland
Department of Occupational Therapy, Cork University Hospital, Cork, Ireland.
BMJ Open Qual. 2022 Jun;11(2). doi: 10.1136/bmjoq-2021-001676.
Delirium is a serious medical condition that is common in older adults in acute settings. Clinical practice guidelines recommend that all older patients in acute care settings should be screened for delirium using standardised outcome measures.
In our institution, an audit showed that only 16% of older adults presenting to the emergency department were screened for delirium. The goal of this project was to increase the number of patients being screened for delirium using Lean Six Sigma (LSS) methodology and tools and a multidisciplinary approach.
A multidisciplinary team in the emergency department used LSS tools and methodology over a 12-week period to first identify why patients were not being screened for delirium using root cause analysis and second to implement a multifaceted intervention including education, audits and feedback, documentation changes and team huddles. An audit was performed at the 11th week of the project to measure how many patients were being screened for delirium post project intervention.
Results at 5 weeks post intervention (11th week of project) showed that the percentage of patients being screened for delirium had increased from 16% to 82%. A follow-up audit at 17 weeks post intervention showed a further improvement in delirium screening to 92%.
Applying LSS tools and methodology resulted in a healthcare quality improvement. Delirium screening in an emergency department can be improved through multifaceted interventions including education, documentation changes and team huddle changes.
谵妄是一种常见于急性环境下老年患者的严重医学病症。临床实践指南建议，所有急性护理环境下的老年患者都应使用标准化的评估工具筛查谵妄。
在我们的机构中，一项审计显示，只有 16%的老年急诊患者接受了谵妄筛查。该项目的目标是通过精益六西格玛（LSS）方法和工具以及多学科方法增加接受谵妄筛查的患者数量。
急诊部的多学科团队在 12 周内使用 LSS 工具和方法，首先通过根本原因分析确定为什么没有对患者进行谵妄筛查，其次实施多方面的干预措施，包括教育、审计和反馈、文档更改和团队会议。在项目的第 11 周进行了一次审计，以衡量项目干预后有多少患者接受了谵妄筛查。
干预后 5 周（项目第 11 周）的结果显示，接受谵妄筛查的患者比例从 16%增加到 82%。干预后 17 周的后续审计显示，谵妄筛查进一步提高至 92%。
应用 LSS 工具和方法导致了医疗质量的改善。通过教育、文档更改和团队会议更改等多方面干预措施可以改善急诊科的谵妄筛查。
