Emergency Department at Hackensack University Medical Center Screening for Delirium

Pilot program leads to improved screening compliance and streamlined consult orders in emergency care settings

In early 2023, Hackensack University Medical Center rolled out a pilot delirium triage screen program with Epic-accessible, standardized protocols specific to the emergency department.

With feedback and collaboration from ED nursing staff, the Emergency Medicine team shifted from providing a CAM screening for delirium in the ED setting to the Ottawa 3DY Dementia screening tool, which they found better suited to the emergency care setting.

Screening compliance jumped from just 10% to over 72% with these changes. Future plans include expanding the pilot to other Hackensack Meridian Health emergency departments. This pilot is part of a broader effort to detect, prevent and address delirium in older patients across the hospital.

The team is currently optimizing action plans for positive screens into the electronic health record, including refinements such as user-friendliness and automatic routing of positive results to Geriatric Medicine for consultation, with care pathways for patients admitted to the hospital or released home.

The Division of Geriatrics in collaboration with the nursing team uses a delirium prevention bundle, which includes multiple non-pharmacological interventions. An early initiation of this bundle promotes a protocol of routine and orientation.It includes a daily checklist of time awareness practices, such as referencing an analog clock, updating white boards with the date and day of the week, and practicing orienting conversations such as next meal, time of day and current events. The checklist also includes practices to help structure daily routine, such as oral hygiene, an evening warm beverage, hand/back massage and evening light dimming.Other practices support engagement, such as offering an activity packet and pencil, eyeglasses and hearing aids. The checklist also promotes ambulatory movement multiple times a day, regular toileting and taking meals out of bed.

The recent geriatrics-psychiatry collaboration is using this tool as an important intervention for patients at risk of delirium. Both teams are using an Epic template, which was created in partnership, for documentation and standardizing assessments and a care plan.

Learn more about innovative geriatric care at Hackensack University Medical Center.