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Group N°6 Els DEVRIENDT (Belgium) Camilla GÖRAS (Sweden)

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Presentation on theme: "Group N°6 Els DEVRIENDT (Belgium) Camilla GÖRAS (Sweden)"— Presentation transcript:

1 Early detection of delirium in older people in the emergency department
Group N°6 Els DEVRIENDT (Belgium) Camilla GÖRAS (Sweden) Sara LEVATI (Italie) Laura-Maria MURTOLA (Finland) Sebastien KEREVER (France) Nijmegen 5th July 2013

2 safety and quality of care impairment
Background Delirium: disturbance of consciousness, attention, cognition, and perception that appears after a short period of time (usually hours to days) and tends to fluctuate during the course of the day Prevalence of delirium: 8-10% of older patients (≥70 yo) admitted to the Emergency Departement, underdiagnosed in 57% to 83% of the cases Multifactorial problem associated with a increasing of: Hospital mortality Hospital length of stay Healthcare costs Long-term functional and cognitive decline Missing delirium detection  Missing diagnosis safety and quality of care impairment Barron EA & Al, 2013; NICE, 2010; Han & Al , 2010; Innoye & Al, 1990; Press & Al, 2009.

3 Question What is the impact of an e-learning program on nurses to improve the early detection of delirium in older patients in an emergency department? Setting: Belgium University hospital in leuven

4 Methods MRC METHODS 1. Developement Evidence base Systematic Review
Qualitative studies: Focus groups Identifying Theory Competency framework Modelling intervention Expert Pannel Meeting 2. Feasibility/piloting Testing procedures Before/After Pilot study Qualitative feasibility study Estimation of recruitment/retention Review of the litterature + a priori information Number of subject needed for the pilot study Sample size determination Inclusion rate estimation

5 Ishikawa - fishbone flowchart (Cause & Effect Diagram)
Environement Competences Underdetection of delirium in older patients in ED TODO check SR and add fishbone Aim SR Screening tool Documentation Ishikawa K , “Introduction to quality control”, 1990.

6 Theoretical framework
% Focus Group: Qualitative part Skills Knowledge Attitudes Behavior Quantitative part Proportion Distribution Functional Competence (Skills) Ethical Competence (Attitudes) Personal Competence (Behavior) Cognitive Competence (Knowledge) Knowledge complex problem delirium Skills eg delirium managing Skills: using screeningsinstruments Focusgroup to identify and quantify the problem of underrecognition of delirium in the ED influencing competence. We want to do that before the intervention. % % % Cheetham G & Al, “Towards a holistic model of professional competence”, J Eur Indus Training, 1996

7 Intervention development
Educational program Philosophy: self constructive program Methods: e-learning platform (modules and toolbox) Content: Skills: using the CAM screening tool, how to deal with the target population Knowledge: incidence, risk factors, consequences, screening methods Attitudes: organisational culture, climate within the team, attitudes towards the population, safety, motivation Behavior: emotional control (aggresivity) Competence tests (part of the e learning) Modelling Expert panel meeting: geriatric and emergency team. Components of the intervention can be …. We will propose this intervention to a group of experts

8 Methodology – Pilot study
Model Monocentric prospective quasi experimental before and after pilot study Primary outcome: proportion of delirium documented during the first 72h at the ED (%) Secondary outcome: Increased competence (questionnaire, nurse competence scales, vignette study) Sample size Attended effect Δ + 20% (systematic review & previous study) α = 5%, power = 90%, two tailed n = 260 Inclusion rate Rate of patient 2/days with delirium (≥ 70 yo) Length 8 months (3 before, 2 teaching, 3 after) n = 360 (+ 40%, refusal, withdraw, dementia, lost to follow up, missing) Cost euros Sample size based on observational study on 442 patients in leuven

9 Future Perspectives Meta analysis
Risk factors (HR), Mortality Multicentric international cluster RCT Long term mortality Long term e-learning Cost Effectiveness Study E learning vs. Cost of avoid delirium

10 Why Us ? Conclusion: “Delirium is a significant concern in the ED, with many delirious patients not identified by physicians. To improve delirium outcomes and hospital management, measures must include mechanisms to improve detection” Barron & Al, 2013 The team experience Els DEVRIENDT (Geriatric and Emergency Room) Camilla GÖRAS (Safety & Quality of care) Sara LEVATI (Complex Intervention & net work tools) Laura-Maria MURTOLA (ICU, management, care organisation) Sebastien KEREVER (ICU, Methodology, Biostatistic) The results Improving Patient outcome Saving institutional money Increase Nursing Competence

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