ArticleAnnals of internal medicine2022
Comparative Implementation of a Brief App-Directed Protocol for Delirium Identification by Hospitalists, Nurses, and Nursing Assistants : A Cohort Study.
Article in Annals of internal medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 30 citations in OpenAlex.
- Development and Usability Testing of a Mobile App-Based Clinical Decision Support System for Delirium: Randomized Crossover Trial.JMIR aging · 2024Trial
- Applying the Age-Friendly Health Systems Framework to Promote Adoption and Sustainability of Interventions for Older Adults in the Intensive Care Unit.Journal of gerontological nursing · 2026Review
- Postoperative Delirium: A Survey of Perceptions Among Surgical Providers.Delirium (Bielefeld, Germany) · 2026Article
- Microglial activation as a hallmark of neuroinflammation in Alzheimer's disease.Metabolic brain disease · 2025Review
- Factors associated with disagreement between clinician app-based ultra-brief Confusion Assessment Method and reference standard delirium assessments.Journal of the American Geriatrics Society · 2024Article
- Optimizing delirium care in the era of Age-Friendly Health System.Journal of the American Geriatrics Society · 2024Article
- Barriers to delirium screening and management during hospital admission: a qualitative analysis of inpatient nursing perspectives.BMC health services research · 2023Article
- A pilot study testing the iOS UB-CAM delirium app.Journal of the American Geriatrics Society · 2023Article
- Recognition of Delirium Superimposed on Dementia: Is There an Ideal Tool?Geriatrics (Basel, Switzerland) · 2023Review
- American Delirium Society 2022 Year in Review: Highlighting the Year's Most Impactful Delirium Research.Delirium communications · 2023Article
- Detecting delirium: a systematic review of ultrabrief identification instruments for hospital patients.Frontiers in psychology · 2023Review
- Comparative salary-related costs of a brief app-directed delirium identification protocol by hospitalists, nurses, and nursing assistants.Journal of the American Geriatrics Society · 2022Article
Corrections and comments
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Authors and funding
13 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundSystematic screening improves delirium identification among hospitalized older adults. Little data exist on how to implement such screening.
objectiveTo test implementation of a brief app-directed protocol for delirium identification by physicians, nurses, and certified nursing assistants (CNAs) in real-world practice relative to a research reference standard delirium assessment (RSDA).
designProspective cohort study.
settingLarge urban academic medical center and small rural community hospital.
participants527 general medicine inpatients (mean age, 80 years; 35% with preexisting dementia) and 399 clinicians (53 hospitalists, 236 nurses, and 110 CNAs). MEASUREMENTS: On 2 study days, enrolled patients had an RSDA. Subsequently, CNAs performed an ultra-brief 2-item screen (UB-2) for delirium, whereas physicians and nurses performed a 2-step protocol consisting of the UB-2 followed in those with a positive screen result by the 3-Minute Diagnostic Assessment for the Confusion Assessment Method.
resultsDelirium was diagnosed in 154 of 924 RSDAs (17%) and in 114 of 527 patients (22%). The completion rate for clinician protocols exceeded 97%. The CNAs administered the UB-2 in a mean of 62 seconds (SD, 51). The 2-step protocols were administered in means of 104 seconds (SD, 99) by nurses and 106 seconds (SD, 105) by physicians. The UB-2 had sensitivities of 88% (95% CI, 72% to 96%), 87% (CI, 73% to 95%), and 82% (CI, 65% to 91%) when administered by CNAs, nurses, and physicians, respectively, with specificities of 64% to 70%. The 2-step protocol had overall accuracy of 89% (CI, 83% to 93%) and 87% (CI, 81% to 91%), with sensitivities of 65% (CI, 48% to 79%) and 63% (CI, 46% to 77%) and specificities of 93% (CI, 88% to 96%) and 91% (CI, 86% to 95%), for nurses and physicians, respectively. Two-step protocol sensitivity for moderate to severe delirium was 78% (CI, 54% to 91%). LIMITATION: Two sites; limited diversity.
conclusionAn app-directed protocol for delirium identification was feasible, brief, and accurate, and CNAs and nurses performed as well as hospitalists. PRIMARY FUNDING SOURCE: National Institute on Aging.
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