Benn Lakeshia, Shah Nirav, McKinney Amy, Min Lillian, Aleem Ilyas, Luzum Matthew, Vlisides Phillip E
Department of Inpatient Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA.
College of Health Professions & McAuley School of Nursing, University of Detroit Mercy, Detroit, MI, USA.
BMC Health Serv Res. 2025 May 7;25(1):655. doi: 10.1186/s12913-025-12829-z.
Delirium often goes unrecognized in the hospital, leading to missed opportunities for management. The objective of this study was to test a multicomponent program for delirium screening and reporting for older, hospitalized adults.
We implemented a multicomponent delirium screening and alerting program within two university hospital units for all patients ≥ 70 years of age. The initiative compared performance of the 4 'A's Test, Nursing Delirium Screening Scale, and Confusion Assessment Method. Additionally, the study team provided recurrent educational sessions with nurses and implemented pager and electronic health record alerts for patients who screened positive for delirium. Nurses were then surveyed about their perspectives, and clinical outcomes were abstracted from the medical record.
Compared to the Confusion Assessment Method, the proportion of positive screens was significantly higher (positive screens/admissions) with the 4 'A's Test (49/448, 11% vs. 12/399, 3%, p < 0.001) and the Nursing Delirium Screening Scale (83/539, 15% vs. 12/399, 3%, p < 0.001). Among surveyed nurses, 32/41 (78%) expressed that the alerting system provided at least "moderate" motivation to screen for delirium, and 35/41 (85%) voiced that it provided at least "moderate" motivation to record positive screens. Most respondents (23/42, 55%) reported recurrent educational sessions as "very helpful." Positive screens were associated with higher mortality (6.6% vs. 1.9%, p = 0.003), longer hospitalizations (13 [± 11] days vs. 7 [± 11], p < 0.001), and higher likelihood of discharge to care facilities (45% vs. 23%, p < 0.001).
Positive delirium screening rates were higher with the 4AT and NuDesc compared to the CAM. Additionally, alerting systems and educational initiatives served as motivating factors for delirium screening and charting.
谵妄在医院中常常未被识别，导致错失管理机会。本研究的目的是测试一项针对老年住院患者的谵妄筛查和报告多组分方案。
我们在两家大学医院的科室中针对所有年龄≥70岁的患者实施了一项多组分谵妄筛查和警报方案。该方案比较了“4A”测试、护理谵妄筛查量表和意识模糊评估法的性能。此外，研究团队为护士提供了定期培训课程，并为谵妄筛查呈阳性的患者实施了传呼机和电子健康记录警报。随后对护士进行了关于他们观点的调查，并从病历中提取临床结果。
与意识模糊评估法相比，“4A”测试（49/448, 11% 对 12/399, 3%, p <0.001）和护理谵妄筛查量表（83/539, 15% 对12/399, 3%, p <0.001）的阳性筛查比例显著更高。在接受调查的护士中，32/41（78%）表示警报系统为谵妄筛查提供了至少“中等程度” 的动力，35/41（85%）表示它为记录阳性筛查结果提供了至少“中等程度” 的动力。大多数受访者（23/42, 55%）报告定期培训课程 “非常有帮助”。阳性筛查与更高的死亡率（6.6% 对1.9%, p =0.003）、更长的住院时间（13 [±11] 天对7 [±11] 天, p <0.001）以及出院到护理机构的更高可能性（45% 对23%, p <0.001）相关。
与意识模糊评估法相比，“4A”测试和护理谵妄筛查量表的谵妄阳性筛查率更高。此外，警报系统和培训举措是谵妄筛查和记录的推动因素。
