Leveraging the Electronic Health Record to Implement Emergency Department Delirium Screening

Authors

Anita N Chary
Elise Brickhouse
Beatrice Torres
Ilianna Santangelo
Christopher R Carpenter
Shan W Liu
Kyler M Godwin
Aanand D Naik
Hardeep Singh
Maura Kennedy

Publication Date

5-1-2023

Journal

Applied Clinical Informatics

DOI

10.1055/a-2073-3736

PMID

37054983

PMCID

PMC10284630

PubMedCentral® Posted Date

6-21-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Aged, Electronic Health Records, Emergency Service, Hospital, Attitude of Health Personnel, Delirium, delirium, screening, geriatrics, electronic health record

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.

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