TY - JOUR
T1 - Beyond grand rounds
T2 - A comprehensive and sequential intervention to improve identification of delirium
AU - Ramaswamy, Ravishankar
AU - Dix, Edward F.
AU - Drew, Janet E.
AU - Diamond, James J.
AU - Inouye, Sharon K.
AU - Roehl, Barbara J.O.
N1 - Funding Information:
This work was supported in part by a grant from Pfizer supporting the 2009 Pfizer Visiting Professorship in Neurology and Psychiatry to Thomas Jefferson University and a grant from the National Institute on Aging (K24AG00949 to S. K. Inouye). S. K. Inouye holds the Milton and Shirley F. Levy Family Chair.
PY - 2011/2
Y1 - 2011/2
N2 - Purpose of the Study:Delirium is a widespread concern for hospitalized seniors, yet is often unrecognized. A comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium was tested.Design and Methods:A 2-day CSI program that consisted of progressive 4-part didactic series, including evidence-based reviews of delirium recognition, prevention, and management, interspersed with interactive small group sessions and practical case conferences was conceptualized in consultation with a leading expert on delirium. Pretest and posttest instruments were designed to test the attendees on their knowledge and confidence around delirium identification.Results:An average of 71 people attended each didactic session. Among all responses, 50 pretests and posttests were matched based on numeric coding (6 MD/DOs, 34 RNs, and 10 others). Mean pretest and posttest scores were 7.9 and 10.8 points, respectively (maximum: 17), showing a positive change in knowledge scores after the intervention (2.9 points, p <. 001). Improvement in knowledge scores was higher in the cohort attending 2 or more lectures (3.8 points, p <. 001) compared with those attending only 1 lecture (1.3 points, p <. 12). Confidence in identifying patients with delirium increased by 28% (p <. 001), and self-assessed capacity to correctly administer the Confusion Assessment Method increased by 36% (p <. 001).Implications:A novel CSI increased clinician knowledge about delirium identification and management and improved confidence and self-assessed capacity to identify delirium in the hospitalized elderly patients. This strategy, which incorporates multiple reinforcing modes of education, may ultimately be more effective in influencing clinician behavior when compared with traditional grand rounds.
AB - Purpose of the Study:Delirium is a widespread concern for hospitalized seniors, yet is often unrecognized. A comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium was tested.Design and Methods:A 2-day CSI program that consisted of progressive 4-part didactic series, including evidence-based reviews of delirium recognition, prevention, and management, interspersed with interactive small group sessions and practical case conferences was conceptualized in consultation with a leading expert on delirium. Pretest and posttest instruments were designed to test the attendees on their knowledge and confidence around delirium identification.Results:An average of 71 people attended each didactic session. Among all responses, 50 pretests and posttests were matched based on numeric coding (6 MD/DOs, 34 RNs, and 10 others). Mean pretest and posttest scores were 7.9 and 10.8 points, respectively (maximum: 17), showing a positive change in knowledge scores after the intervention (2.9 points, p <. 001). Improvement in knowledge scores was higher in the cohort attending 2 or more lectures (3.8 points, p <. 001) compared with those attending only 1 lecture (1.3 points, p <. 12). Confidence in identifying patients with delirium increased by 28% (p <. 001), and self-assessed capacity to correctly administer the Confusion Assessment Method increased by 36% (p <. 001).Implications:A novel CSI increased clinician knowledge about delirium identification and management and improved confidence and self-assessed capacity to identify delirium in the hospitalized elderly patients. This strategy, which incorporates multiple reinforcing modes of education, may ultimately be more effective in influencing clinician behavior when compared with traditional grand rounds.
KW - Clinician education program
KW - Confusion Assessment Method
KW - Continuing medical education
KW - Multifaceted Interaction
UR - http://www.scopus.com/inward/record.url?scp=78751559364&partnerID=8YFLogxK
U2 - 10.1093/geront/gnq075
DO - 10.1093/geront/gnq075
M3 - Article
C2 - 20855818
AN - SCOPUS:78751559364
SN - 0016-9013
VL - 51
SP - 122
EP - 131
JO - The Gerontologist
JF - The Gerontologist
IS - 1
ER -