2023 GEMSSTAR for Emergency Medicine Supplemental Funding Program - $25,000

"Identifying Implementation Strategies for Emergency Department Delirium Screening in Older Adults"

Delirium, or acute brain failure, affects 15% of older adults presenting to emergency care and is associated with functional and cognitive decline, increased mortality, and billions of dollars in annual health care costs. However, delirium is not detected in two-thirds of emergency department (ED) cases. The ED is an important site for evaluation of delirium in an older adult's care trajectory, as early recognition of delirium in the ED may lead to improved prevention and treatment, downstream health outcomes, and reduced costs. Most EDs do not routinely screen older adults for delirium, but a minority have adopted evidence-based delirium screening recommended in the Geriatric ED Guidelines. Doctor Chary’s GEMSSTAR research focuses on identifying strategies from these early adopter EDs for successful implementation of delirium screening.

The ED environment represents a challenging context to implement a delirium detection protocol. For example, crowding, hallway care, variable acuity, and staff shortages can make carrying out a screening process complex--particularly a process aimed at identifying a patient's waxing and waning mental status. Doctor Chary’s GEMSSTAR research uses an implementation science framework to identify such barriers to implementing ED delirium screening as well as strategies to overcome them. This investigation uses qualitative methods to understand both frontline clinicians’ and clinician-administrators’ perspectives. The research aims to generate novel data about a breadth of approaches to ED delirium screening nationwide while also providing granular data about ground-level implementation.