Neuro Delirium and Dementia Screening Protocols Aim to Enhance Patient Outcomes and Experience

Hackensack University Medical Center’s program is poised to improve screening compliance and streamline care protocols for older adults in emergency care settings

Hackensack University Medical Center has established delirium and dementia screening protocols in the Emergency Department (ED) designed with senior safety and well-being in mind.

Initially implementing a delirium screening pilot program in early 2023, the ED team has since refined their protocols to incorporate the Ottawa 3DY screening tool to enhance outcomes and improve patient experience during what could prove to be an upsetting or disorienting experience for elderly patients.

“This program is part of a broader effort to detect, prevent and address delirium in older patients across the hospital,” said Manisha Parulekar, M.D., AGSF, FACP, director, Division of Geriatrics and co-director, Center for Memory Loss and Brain Health at Hackensack University Medical Center. “With the addition of the Ottawa dementia screening tool, we can now optimize action plans for patients who screen positive for delirium and dementia using our electronic health record — starting when they first arrive at our ED.”

Cognitive impairment, both dementia and delirium, is common in older patients presenting to the Emergency Department. The Ottawa 3DY consists of 4 questions: What is the Day? What is the Date? Spell the word “word” backwards; and What is the Year? to detect an altered mental status. If any of the questions are answered incorrectly, the patient is likely to have cognitive impairment requiring a further care action plan.

According to Dr. Parulekar, these action plans include referring patients to geriatric medicine for consultation and creating care pathways for admitted or released patients.

Optimized care for older adults also includes a delirium prevention “bundle” of multiple non-pharmacological interventions used by the nursing team to promote routine and orientation. Nurses encourage awareness of time throughout the day by referencing an analog clock, updating the patient’s whiteboard with the date and day of the week, and orienting patients to daily events, such as mealtimes, current events, and personal care routines. In addition to encouraging patients to get out of bed as they can, nurses also offer activity packets, pencils, eyeglasses and hearing aids to keep patients engaged.

“Our neurology, geriatrics, psychiatry, nursing and emergency department teams are working together to find new strategies to help reduce the risk of delirium and assist patients with dementia,” said Dr. Parulekar, who also holds a position as associate professor of Internal Medicine at Hackensack Meridian School of Medicine. “We understand that hospitalization can be stressful for our older patients and their families, and our goal is to minimize the impact of delirium and dementia on health outcomes.”

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