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

Liron Sinvani, MD; Craig Hertz, DO; Saurabh Chandra, MD; Anum Ilyas, BS; Suzanne Ardito, MA; Negin Hajizadeh, MD

Disclosures

Am J Crit Care. 2022;31(1):73-76. 

In This Article

Abstract and Introduction

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.

Introduction

Delirium is one of the most common and devastating complications in the intensive care unit (ICU), affecting up to 80% of patients. Delirium is associated with a mortality rate of more than 30%, lasting cognitive and functional decline, and annual health care expenditures exceeding $182 billion.[1] Although early detection of delirium is critical for timely and effective management, previous studies have demonstrated that clinicians fail to recognize delirium in up to 75% of cases.[2]

Standardizing delirium screening and management in all critically ill patients has become a national priority.[3] The Confusion Assessment Method for the ICU (CAM-ICU) is the most widely used and validated delirium screening tool. The CAMICU has high sensitivity and specificity when performed by delirium experts, highly trained ICU clinicians, and researchers.[4] However, when used in routine ICU practice, the sensitivity drops to 47%.[5]

The gap in translating evidence-based tools into daily practice in the ICU environment calls for innovative strategies. Although telehealth in the ICU (tele-ICU) has become instrumental in providing clinical care, its use as a training platform for delirium has not been explored.[6]

The objective of this study was to evaluate the feasibility and acceptability of using the tele-ICU platform to provide delirium (tele-delirium) training across a large health system.

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