Presentation on theme: "Group N°6 Els DEVRIENDT (Belgium) Camilla GÖRAS (Sweden)"— Presentation transcript:
1Early detection of delirium in older people in the emergency department Group N°6Els DEVRIENDT (Belgium)Camilla GÖRAS (Sweden)Sara LEVATI (Italie)Laura-Maria MURTOLA (Finland)Sebastien KEREVER (France)Nijmegen 5th July 2013
2safety and quality of care impairment BackgroundDelirium: 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 dayPrevalence of delirium: 8-10% of older patients (≥70 yo) admitted to the Emergency Departement, underdiagnosed in 57% to 83% of the casesMultifactorial problem associated with a increasing of:Hospital mortalityHospital length of stayHealthcare costsLong-term functional and cognitive declineMissing delirium detection Missing diagnosissafety and quality of care impairmentBarron EA & Al, 2013; NICE, 2010; Han & Al , 2010; Innoye & Al, 1990; Press & Al, 2009.
3QuestionWhat 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
4Methods MRC METHODS 1. Developement Evidence base Systematic Review Qualitative studies: Focus groupsIdentifying TheoryCompetency frameworkModelling interventionExpert Pannel Meeting2. Feasibility/pilotingTesting proceduresBefore/After Pilot studyQualitative feasibility studyEstimation of recruitment/retentionReview of the litterature + a priori informationNumber of subject needed for the pilot studySample size determinationInclusion rate estimation
5Ishikawa - fishbone flowchart (Cause & Effect Diagram) EnvironementCompetencesUnderdetection of delirium in older patients in EDTODO check SR and add fishboneAim SRScreening toolDocumentationIshikawa K , “Introduction to quality control”, 1990.
6Theoretical framework %Focus Group:Qualitative partSkillsKnowledgeAttitudesBehaviorQuantitative partProportionDistributionFunctional Competence (Skills)Ethical Competence (Attitudes)Personal Competence (Behavior)Cognitive Competence (Knowledge)Knowledge complex problem deliriumSkills eg delirium managingSkills: using screeningsinstrumentsFocusgroup 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
7Intervention development Educational programPhilosophy: self constructive programMethods: e-learning platform (modules and toolbox)Content:Skills: using the CAM screening tool, how to deal with the target populationKnowledge: incidence, risk factors, consequences, screening methodsAttitudes: organisational culture, climate within the team, attitudes towards the population, safety, motivationBehavior: emotional control (aggresivity)Competence tests (part of the e learning)ModellingExpert panel meeting: geriatric and emergency team.Components of the intervention can be ….We will propose this intervention to a group of experts
8Methodology – Pilot study ModelMonocentric prospective quasi experimental before and after pilot studyPrimary outcome: proportion of delirium documented during the first 72h at the ED (%)Secondary outcome: Increased competence (questionnaire, nurse competence scales, vignette study)Sample sizeAttended effect Δ + 20% (systematic review & previous study)α = 5%, power = 90%, two tailedn = 260Inclusion rateRate 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 eurosSample size based on observational study on 442 patients in leuven
9Future Perspectives Meta analysis Risk factors (HR), MortalityMulticentric international cluster RCTLong term mortalityLong term e-learningCost Effectiveness StudyE learning vs. Cost of avoid delirium
10Why 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, 2013The team experienceEls 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 resultsImproving Patient outcomeSaving institutional moneyIncrease Nursing Competence