Clinical Decision Support System and Incidence of Delirium in Cognitively Impaired Older Adults Transferred to Intensive Care
Clinical Decision Support
System and Incidence of Delirium in Cognitively Impaired Older Adults Transferred to Intensive Care Background: The elderly population with cognitive impairment have an increased risk of developing delirium, while in ICU
The author's objective is to evaluate the efficacy of a CDSS that provides suggestions on future consultation as well as dissuade the use of urinary catheters, restraints and the administering of anticholinergic drugs in the attempt to minimize the frequency of delirium.
Patients where to be included if they were previously transferred to the ICU; whom are previously participating in the e-Champ trail from July 1, 2006 to March 30, 2008. The study was conducted at Wishard Memorial Hospital, which consisted of 457 beds with 22 beds within the ICU. Patients were considered if they were at least 65 years of age, and transferred to ICU. The disqualifying criteria included, previously enrolled in other studies, were aphasic, or were unresponsive at the time of the screening. The Regenstrief Medical Record System was used to collect and process a fast amount of data. Furthermore, the hospital used the GOPHER physicians Order-Entry System. These systems where linked so that the physicians electronic interactions where monitored and recorded. Patients where initially given the Short Portable Mental Status Questionnaire to locate a base for their cognitive status. The data was provided to the GOPHER system while the Regenstrief system was used to gather demographic information about the patients and provide an appropriate analysis. The outcomes that were measured were orders for conciliation with a geriatrician or orders to discontinue one of the 18 inappropriate anticholinergic medications, urinary catheters or physical restraints.
Out of the 60 patients that came from the population of 424 patients and which were transferred to ICU, 30 were selected as the control group and 30 as the test group. The results showed no difference in the length of stay or survival rate 30 days after discharge from neither the control group nor the test group.
The outcomes show that using a CDSS to stimulate the behavior of health care providers in entering orders for patients with cognitive impairment neither improved orders for early consultation with a geriatrician nor diminished the use of urinary catheters, physical restraints, and anticholinergic agents
I find this article to be very interesting due in fact it does not provide solid evidence proving or disproving of the positive effects of a CDSS. I believe this shows a deeper underlining problem that should be addressed with the use of the CDSS.
Clinical Decision Support System and Incidence of Delirium in Cognitively Impaired Older Adults Transferred to Intensive Care. (n.d.). Retrieved November 11, 2015, from [http://ajcc.aacnjournals.org/content/22/3/257.long ]