Instituting Nurse-Led Delirium Screening in a Windowless Emergency Department-Adjacent Observation Unit: Findings From a Quality Improvement Project.

INTRODUCTION

During the COVID‑19 pandemic, a 12‑bed windowless modular Medical Care Unit (MCU) was rapidly assembled to alleviate emergency department overcrowding, increase capacity for boarded patients, and improve patient throughput. As hospitals continue to face challenges associated with prolonged emergency department boarding, ensuring patient safety in alternative care settings remains a critical priority. Concerns were raised regarding the potential risk of delirium among patients cared for in this emergency-adjacent unit.

METHODS

A nursing‑led quality improvement project was conducted using the Plan‑Do‑Study‑Act framework to implement delirium screening in the MCU. Nurses were trained to use the Confusion Assessment, an evidence‑based delirium screening tool, upon unit admission and every 12 hours thereafter. Screening adherence and delirium occurrence were tracked through the electronic medical record over an 18‑month period.

RESULTS

Between January 2021 and October 2022, nearly 1,300 patients were admitted to the emergency-adjacent Medical Care Observation Unit. Delirium screening adherence exceeded 80% and was sustained throughout the project. Among screened patients, 11 cases of incident delirium (0.96%) and 13 cases of prevalent delirium (1.1%) were identified.

DISCUSSION: Implementation of evidence-based, nursing‑led delirium screening supported safe patient care delivery in a windowless emergency-adjacent medical observation unit designed to alleviate emergency department boarding and overcrowding. Low rates of delirium and sustained screening adherence suggest that such units can serve as a viable strategy for expanding capacity during periods of operational strain while maintaining attention to patient safety and quality of care.