Using Telehealth to Improve the Accuracy of Delirium Screening by Bedside Critical Care Nurses

Author:

Sinvani Liron1,Hertz Craig2,Chandra Saurabh3,Ilyas Anum4,Ardito Suzanne5,Hajizadeh Negin6

Affiliation:

1. Liron Sinvani is a researcher, Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York; an associate professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; and a geriatrician-hospitalist, Division of Geriatrics and Palliative Medicine and Division of Hospital Medicine, Department of Medicine, Northwell Health.

2. Craig Hertz is an assistant professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; a director, Tele-Intensive Care Unit (eICU), Division of TeleHealth, Northwell Health; and an intensivist, Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health.

3. Saurabh Chandra is an assistant professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; a director, Tele-Intensive Care Unit (eICU), Northwell Health; and an intensivist, Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health.

4. Anum Ilyas is a research assistant, Center for Health Innovations and Outcomes Research, Northwell Health.

5. Suzanne Ardito is a research coordinator, Center for Health Innovations and Outcomes Research, Northwell Health.

6. Negin Hajizadeh is a researcher, Center for Health Innovations and Outcomes Research, Northwell Health; an associate professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; and an intensivist, Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health.

Abstract

Background Delirium affects up to 80% of patients in the intensive care unit (ICU) but is missed in up to 75% of cases. Telehealth in the ICU (tele-ICU) has become the standard for providing timely, expert care to remotely located ICUs. Objectives This pilot study assessed the feasibility and acceptability of using tele-ICU to increase the accuracy of delirium screening and recognition by ICU nurses. Methods The pilot sites included 4 ICUs across 3 hospitals. A geriatrician with delirium expertise remotely observed 13 bedside ICU nurses administering the Confusion Assessment Method for the ICU (CAM-ICU) to patients in real time via the tele-ICU platform and subsequently provided training on CAM-ICU performance and delirium management. Training evaluation consisted of a validated spot check form, a 2-item satisfaction/change-of-practice survey, and a qualitative question on acceptability. Results Thirteen ICU nurses were observed performing 26 bedside delirium assessments. The top observed barriers to accurate delirium screening were CAM-ICU knowledge deficits, establishment of baseline cognition, and inappropriate use of the “unable to assess” designation. The mean percentage of correct observations improved from 40% (first observation) to 90% (second observation) (P < .001). All 13 nurses strongly agreed that the training was beneficial and practice changing. Conclusions The use of tele-ICU to improve the accuracy of delirium screening by ICU nurses appears to be feasible and efficient for leveraging delirium expertise across multiple ICUs. Future studies should evaluate the effects of tele-ICU delirium training on patient-centered outcomes.

Publisher

AACN Publishing

Subject

Critical Care Nursing,General Medicine

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Improving the Recognition and Assessment of ICU Delirium;The Journal of Continuing Education in Nursing;2024-09-05

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