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


Am J Crit Care. 2022;31(1):73-76. 

In This Article


Thirteen nurses from 4 ICUs (1 medical, 1 surgical, and 2 mixed) and 3 hospitals (1 tertiary and 2 community) were observed performing 26 CAM-ICU assessments. Each nurse was observed 2 times with 2 different patients. Assessments were made from the remote tele-ICU hub.

The mean time spent for each observation, which included the nurse's CAM-ICU assessment and the geriatrician-hospitalist's feedback and training, was 9 minutes. The most frequently identified errors during observation were incorrect RASS assessment; trouble with CAM-ICU administration (being unsure of how to start, administering features in an inconsistent order, and administering features inaccurately); lack of awareness of the patient's baseline cognitive status or how to obtain this information; inappropriate use of the "unable to assess" designation; confusion regarding CAM-ICU timing (while patients were receiving or not receiving sedation); and performing the CAM-ICU in difficult situations such as in patients who had developmental delay or did not speak English.

The mean number of correct observations, of a maximum of 6 (1 RASS, 4 features of the CAM-ICU, and 1 overall CAM-ICU), improved from 2.4 (40%) to 5.4 (90%) after tele-delirium training (P < .001). All 13 nurses (100%) strongly agreed that the training was beneficial and practice changing.

Feedback from nurses was extremely positive. One participant, a bedside ICU nurse for more than 10 years, reported that for the first time she finally understood how to assess patients for delirium. Nurses also reported that they felt more comfortable with and less threatened by receiving training via tele-ICU compared with having someone watching them over their shoulder.