Using the Electronic Medical Record to Identify and Screen Patients at Risk for Delirium (Iowa)

This is one of twelve projects funded by the Agency for Healthcare Research and Quality to inform Stage 3 Meaningful Use (MU) requirements through evidence. Delirium is represented by an altered state of consciousness and includes confusion, disorientation, illusions, hallucinations, and agitation. More commonly seen in the elderly, its causes include infection, dehydration, medication toxicity, polypharmacy, and dementia. The condition is associated with many negative outcomes, including increased lengths of hospital stays, long-term care placement, development of dementia, mortality, and health care costs. As such, delirium represents a major public health issue for the elderly.

This project will develop an electronic medical record (EMR) screening program to identify and screen hospitalized older adults who are at risk for delirium, so that recognition and treatment of this condition may be improved. The project team will evaluate metrics related to identification of medical problems in real-time and improving accuracy of the problem list.

The specific aims of this project are to use the EMR to:

• Identify delirium risk factors and develop a delirium prediction rule. 
• Generate a list of patients at risk for delirium in real time. 
• Improve documentation of delirium in the problem list. 

At the start of the project delirium risk factors will be identified from the EMR among hospitalized patients who are 64 years or older. A prediction rule of delirium will be created and implemented into the EMR so that patients at higher risk are identified for screening. This rule will be evaluated and validated to ensure accuracy of the predication model. After validation, the team will develop another clinical decision support tool that will prompt clinicians to document delirium in the problem list for patients with a positive delirium screen. The team will also conduct a survey to evaluate nurses’ and physicians' satisfaction.

This project’s resulting EMR-facilitated screening program will increase the recognition of delirium in the inpatient population, with the goal to decrease health care costs and improve patient and family satisfaction. By identifying patients at high risk, the program will allow for both prevention of delirium and earlier treatment and resolution. This project will fill critical knowledge gaps to inform MU policy and practice implementation.