Language discordance in emergency department delirium screening: Results from a qualitative interview‐based study

Chary, Anita; Torres, Beatrice; Brickhouse, Elise; Santangelo, Ilianna; Godwin, Kyler M.; Naik, Aanand D.; Carpenter, Christopher R.; Liu, Shan W.; Kennedy, Maura

doi:10.1111/jgs.18147

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…Healthcare providers should be aware of these factors and seek to address them to ensure that family involvement in delirium detection is effective and accurate. Moreover, potential health inequities such as structural racism, ageism, and language discordance should not be overlooked in future studies 43,44 . This review included studies of multiple languages and ethnic settings, and health inequities were addressed by including a representative sample of participants from different racial, ethnic, and socioeconomic backgrounds, not excluding older adults of varying degrees of decision‐making capacity, as well as using translated versions of the FAM‐CAM.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of the Family Confusion Assessment Method for delirium detection: A systematic review and meta‐analysis

Zhou,

Wang,

Wang

et al. 2023

J American Geriatrics Society

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BackgroundDelirium is frequently disproportionately under‐recognized despite its high prevalence, detrimental impact, and potential lethality. Informant‐based delirium detection tools can offer structured assessment and increase the timeliness and frequency of detection. We aimed to examine the diagnostic accuracy of the Family Confusion Assessment Method (FAM‐CAM) for delirium detection.MethodsWe systematically searched the MEDLINE, EMBASE, PsycINFO, CINAHL, CNKI, WANFANG, and SinoMed databases from January 1988 to December 2022. Two reviewers independently screened studies and evaluated methodological quality using the revised quality assessment of diagnostic accuracy studies (QUADAS‐2) tool. A bivariate random effects model was undertaken, and univariable meta‐regression was carried out to explore heterogeneity.ResultsSeven studies with 483 dyads of participants and family caregivers were identified. Pooled sensitivity and specificity were 0.74 (95% CI: 0.59, 0.86) and 0.91 (95% CI: 0.83, 0.95), respectively, with an area under curve (AUC) of 0.91. The positive likelihood ratio was 8.27 (95% CI: 3.97, 17.25), and the negative likelihood ratio was 0.28 (95% CI: 0.16, 0.50). Settings impacted specificity (p = 0.02).ConclusionsAvailable evidence indicates that FAM‐CAM exhibits moderate sensitivity and high specificity for delirium screening in adults. The FAM‐CAM is concise and easy to use, making it appropriate for routine clinical practice, which might benefit early delirium detection and potentially foster delirium management.PROSPERO Registration NumberCRD42022378742.

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of the Family Confusion Assessment Method for delirium detection: A systematic review and meta‐analysis

Zhou,

Wang,

Wang

et al. 2023

J American Geriatrics Society

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“…One study found that sarcopenia predicted frailty and ED revisits and hospitalization 75 . Chary et al 76 . indicated that PT consultation potentially benefits older adults in the ED, but best practice recommendations are not yet available.…”

Section: Ms Frameworkmentioning

confidence: 99%

Enhancing healthcare access for an older population: The age‐friendly emergency department

Lee,

Skains,

Magidson

et al. 2024

JACEP Open

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Healthcare systems face significant challenges in meeting the unique needs of older adults, particularly in the acute setting. Age‐friendly healthcare is a comprehensive approach using the 4Ms framework—what matters, medications, mentation, and mobility—to ensure that healthcare settings are responsive to the needs of older patients. The Age‐Friendly Emergency Department (AFED) is a crucial component of a holistic age‐friendly health system. Our objective is to provide an overview of the AFED model, its core principles, and the benefits to older adults and healthcare clinicians. The AFED optimizes the delivery of emergency care by integrating age‐specific considerations into various aspects of (1) ED physical infrastructure, (2) clinical care policies, and (3) care transitions. Physical infrastructure incorporates environmental modifications to enhance patient safety, including adequate lighting, nonslip flooring, and devices for sensory and ambulatory impairment. Clinical care policies address the physiological, cognitive, and psychosocial needs of older adults while preserving focus on emergency issues. Care transitions include communication and involving community partners and case management services. The AFED prioritizes collaboration between interdisciplinary team members (ED clinicians, geriatric specialists, nurses, physical/occupational therapists, and social workers). By adopting an age‐friendly approach, EDs have the potential to improve patient‐centered outcomes, reduce adverse events and hospitalizations, and enhance functional recovery. Moreover, healthcare clinicians benefit from the AFED model through increased satisfaction, multidisciplinary support, and enhanced training in geriatric care. Policymakers, healthcare administrators, and clinicians must collaborate to standardize guidelines, address barriers to AFEDs, and promote the adoption of age‐friendly practices in the ED.

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“…70 For example, algorithms which estimate future healthcare needs based on past utilization (e.g., prior ED visits or prior hospitalizations) would necessarily prioritize patients with more access to care. 69 While manual screening tools are not immune to biases, 71,72 they are of particular concern when moving to automated workflows. Fortunately, as the data science enabling automated workflows has advanced, so have techniques to evaluate and mitigate bias in algorithm development and deployment.…”

Section: Challenges Limitations and Future Directionsmentioning

confidence: 99%

Automating risk stratification for geriatric syndromes in the emergency department

Haimovich,

Shah,

Southerland

et al. 2023

J American Geriatrics Society

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BackgroundGeriatric emergency department (GED) guidelines endorse screening older patients for geriatric syndromes in the ED, but there have been significant barriers to widespread implementation. The majority of screening programs require engagement of a clinician, nurse, or social worker, adding to already significant workloads at a time of record‐breaking ED patient volumes, staff shortages, and hospital boarding crises. Automated, electronic health record (EHR)‐embedded risk stratification approaches may be an alternate solution for extending the reach of the GED mission by directing human actions to a smaller subset of higher risk patients.MethodsWe define the concept of automated risk stratification and screening using existing EHR data. We discuss progress made in three potential use cases in the ED: falls, cognitive impairment, and end‐of‐life and palliative care, emphasizing the importance of linking automated screening with systems of healthcare delivery.ResultsResearch progress and operational deployment vary by use case, ranging from deployed solutions in falls screening to algorithmic validation in cognitive impairment and end‐of‐life care.ConclusionsAutomated risk stratification offers a potential solution to one of the most pressing problems in geriatric emergency care: identifying high‐risk populations of older adults most appropriate for specific GED care. Future work is needed to realize the promise of improved care with less provider burden by creating tools suitable for widespread deployment as well as best practices for their implementation and governance.

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Language discordance in emergency department delirium screening: Results from a qualitative interview‐based study

Cited by 8 publications

References 11 publications

Diagnostic accuracy of the Family Confusion Assessment Method for delirium detection: A systematic review and meta‐analysis

Diagnostic accuracy of the Family Confusion Assessment Method for delirium detection: A systematic review and meta‐analysis

Enhancing healthcare access for an older population: The age‐friendly emergency department

Automating risk stratification for geriatric syndromes in the emergency department

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