General hospital psychiatry · 2026
Real-world implementation of an electronic medical record-integrated application based on the DELirium Team Approach program: A pilot study.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Takahashi Keitaro, Kiryu Kana, Tamamoto Kazunori, Ito Chinatsu, Sato Takashi, Katsumata Shintaro, Kaneta Satoshi, Ogawa Asao, Kato Tadafumi, Tamune Hidetaka
Аннотация
OBJECTIVE: Delirium remains under-recognized. We evaluated feasibility and exploratory outcomes of a DELirium Team Approach-based intervention combining a 1-h educational program with an electronic medical record-integrated application.
METHODS: We conducted a single-center before-after study in an intermediate care unit with 8-week pre-intervention and intervention periods. Adults without delirium on admission were enrolled. Primary outcome was chart-based identification of new-onset delirium within 48 h. Process evaluation included application logs, post-implementation nurse questionnaires, and structured interviews.
RESULTS: Among 104 patients, new-onset delirium occurred in 28.9% (13/45) during the pre-intervention period and 15.3% (9/59) during the intervention period (risk difference, -13.6%; 95% CI, -29.7% to 2.5%; relative risk, 0.53; 95% CI, 0.25 to 1.13; p = 0.15). Patient-level application utilization was 100%. Of 23 nurses who used the application, 19 completed care-plan preparation within 10 min. Approximately 80% reported assessing pain, dehydration, and constipation in at least 50% of applicable opportunities, whereas corresponding actions were reported by 41.7%-58.3% and discussions of risk medications by 25.0%.
CONCLUSIONS: This pilot study supports the feasibility of integrating DELTA-based structured assessments into routine acute care, although translation into corresponding bedside and multidisciplinary actions remained inconsistent. Large-scale controlled studies using objective process measures are warranted.
METHODS: We conducted a single-center before-after study in an intermediate care unit with 8-week pre-intervention and intervention periods. Adults without delirium on admission were enrolled. Primary outcome was chart-based identification of new-onset delirium within 48 h. Process evaluation included application logs, post-implementation nurse questionnaires, and structured interviews.
RESULTS: Among 104 patients, new-onset delirium occurred in 28.9% (13/45) during the pre-intervention period and 15.3% (9/59) during the intervention period (risk difference, -13.6%; 95% CI, -29.7% to 2.5%; relative risk, 0.53; 95% CI, 0.25 to 1.13; p = 0.15). Patient-level application utilization was 100%. Of 23 nurses who used the application, 19 completed care-plan preparation within 10 min. Approximately 80% reported assessing pain, dehydration, and constipation in at least 50% of applicable opportunities, whereas corresponding actions were reported by 41.7%-58.3% and discussions of risk medications by 25.0%.
CONCLUSIONS: This pilot study supports the feasibility of integrating DELTA-based structured assessments into routine acute care, although translation into corresponding bedside and multidisciplinary actions remained inconsistent. Large-scale controlled studies using objective process measures are warranted.