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Appl Clin Inform 2023; 14(03): 478-486
DOI: 10.1055/a-2073-3736
Research Article

Leveraging the Electronic Health Record to Implement Emergency Department Delirium Screening

Anita N. Chary
1   Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, United States
2   Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
3   Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
,
Elise Brickhouse
4   School of Medicine, Baylor College of Medicine, Houston, Texas, United States
,
Beatrice Torres
5   University of Texas School of Public Health, UT Health Science Center, Houston, Texas, United States
,
Ilianna Santangelo
6   Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Christopher R. Carpenter
7   Department of Emergency Medicine, Barnes Jewish Hospital, Washington University School of Medicine, Emergency Care Research Core, St. Louis, Missouri, United States
,
Shan W. Liu
6   Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
8   Harvard Medical School, Boston, Massachusetts, United States
,
Kyler M. Godwin
2   Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
3   Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
,
Aanand D. Naik
3   Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
5   University of Texas School of Public Health, UT Health Science Center, Houston, Texas, United States
9   University of Texas Health Consortium on Aging, Houston, Texas, United States
,
Hardeep Singh
2   Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
3   Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States
,
Maura Kennedy
6   Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
8   Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations Funding This research was supported by the National Institute for Aging (1R03AG078943-01) and the Curtis Hankamer Basic Research Fund and Chao-Physician Scientist Award at Baylor College of Medicine (A. N. C.). A. N. C., K. M. G., A. D. N., and H. S. receive support from the Houston Veterans Administration Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety (grant number: CIN13-413).
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Abstract

Objective The aim of this study is to understand how emergency departments (EDs) use health information technology (HIT), and specifically the electronic health record (EHR), to support implementation of delirium screening.

Methods We conducted semi-structured interviews with 23 ED clinician-administrators, representing 20 EDs, about how they used HIT resources to implement delirium screening. Interviews focused on challenges participants experienced when implementing ED delirium screening and EHR-based strategies they used to overcome them. We coded interview transcripts using dimensions from the Singh and Sittig sociotechnical model, which addresses use of HIT in complex adaptive health care systems. Subsequently, we analyzed data for common themes across dimensions of the sociotechnical model.

Results Three themes emerged about how the EHR could be used to address challenges in implementation of delirium screening: (1) staff adherence to screening, (2) communication among ED team members about a positive screen, and (3) linking positive screening to delirium management. Participants described several HIT-based strategies including visual nudges, icons, hard stop alerts, order sets, and automated communications that facilitated implementation of delirium screening. An additional theme emerged about challenges related to the availability of HIT resources.

Conclusion Our findings provide practical HIT-based strategies for health care institutions planning to adopt geriatric screenings. Building delirium screening tools and reminders to perform screening into the EHR may prompt adherence to screening. Automating related workflows, team communication, and management of patients who screen positive for delirium may help save staff members' time. Staff education, engagement, and access to HIT resources may support successful screening implementation.

Keywords

delirium - screening - geriatrics - electronic health record

Protection of Human and Animal Subjects

This research was approved by the Baylor College of Medicine Institutional Review Board, Houston, TX (H-50838) and deemed exempt by the Partners Healthcare Institutional Review Board, Boston, Massachusetts, United States (identifier: 2021P001558).


Supplementary Material



Publication History

Received: 05 February 2023

Accepted: 06 April 2023

Accepted Manuscript online:
13 April 2023

Article published online:
21 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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