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Group N°6 Els DEVRIENDT (Belgium) Camilla GÖRAS (Sweden) Sara LEVATI (Italie) Laura-Maria MURTOLA (Finland) Sebastien KEREVER (France) Early detection.

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Presentation on theme: "Group N°6 Els DEVRIENDT (Belgium) Camilla GÖRAS (Sweden) Sara LEVATI (Italie) Laura-Maria MURTOLA (Finland) Sebastien KEREVER (France) Early detection."— Presentation transcript:

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

2 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,

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? 3

4 Methods MRCMETHODS 1. Developement Evidence baseSystematic Review Qualitative studies: Focus groups Identifying TheoryCompetency framework Modelling interventionExpert Pannel Meeting 2. Feasibility/piloting Testing proceduresBefore/After Pilot study Qualitative feasibility study Estimation of recruitment/retentionReview of the litterature + a priori information Number of subject needed for the pilot study Sample size determination Inclusion rate estimation 4

5 Ishikawa - fishbone flowchart (Cause & Effect Diagram) Underdetection of delirium in older patients in ED 5 Ishikawa K, Introduction to quality control, Environement Competences Screening tool Documentation

6 Theoretical framework Focus Group: –Qualitative part Skills Knowledge Attitudes Behavior –Quantitative part Proportion Distribution 6 Functional Competence (Skills) Ethical Competence (Attitudes) % % % Cheetham G & Al, Towards a holistic model of professional competence, J Eur Indus Training, 1996 Personal Competence (Behavior) Cognitive Competence (Knowledge) %

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. 7

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 8

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 9

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 10

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