Article type
Abstract
Background. Older adults are at high risk of developing delirium in the emergency department (ED); however, it is under-recognized in routine clinical care. Lack of detection and treatment is associated with poor outcomes, such as mortality. Performance measures (PMs) are needed to identify variations in quality care to influence change and guide improvement. Prior to this study, preliminary quality statements and PMs were developed based on a synthesis of high-quality practice guideline recommendations.
Objective. To gain consensus on a set of guideline-based quality statements and PMs that can be used to evaluate delirium care quality for older ED patients.
Methods. Patient/family representatives were part of a Study Steering Group guiding this research to ensure results were relevant to patients. A 3-round modified e-Delphi study was conducted with ED clinical experts. In each round, participants rated quality statements according to the concepts of importance and actionability, then their associated PMs according to the concept of necessity (1-9 Likert scales), with the ability to comment on each. Consensus and stability were evaluated using a priori criteria using descriptive statistics. Qualitative data was examined to identify themes within and across quality statements and PMs, which went through a participant validation exercise in the final round.
Results. Twenty-two experts participated, 95.5% were from Canada. From 10 quality statements and 24 PMs, consensus was achieved for six quality statements and 22 PMs. Qualitative data supported justification for including three quality statements and one PM that achieved consensus slightly below a priori criteria. Three overarching themes emerged from the qualitative data related to quality statement actionability. Nine quality statements, nine structure PMs, and 14 process PMs are included in the final set, addressing four areas of delirium care: screening, diagnosis, risk reduction and management.
Conclusion. Results provide a contextualized set of guideline-based quality statements and PMs that are important, actionable, and necessary to a diverse group of clinical experts. The final set of quality statements from this study can be used to guide practice change and enhance standardized electronic documentation, and the PMs can provide baseline data to guide improvement efforts where they are most needed.
Objective. To gain consensus on a set of guideline-based quality statements and PMs that can be used to evaluate delirium care quality for older ED patients.
Methods. Patient/family representatives were part of a Study Steering Group guiding this research to ensure results were relevant to patients. A 3-round modified e-Delphi study was conducted with ED clinical experts. In each round, participants rated quality statements according to the concepts of importance and actionability, then their associated PMs according to the concept of necessity (1-9 Likert scales), with the ability to comment on each. Consensus and stability were evaluated using a priori criteria using descriptive statistics. Qualitative data was examined to identify themes within and across quality statements and PMs, which went through a participant validation exercise in the final round.
Results. Twenty-two experts participated, 95.5% were from Canada. From 10 quality statements and 24 PMs, consensus was achieved for six quality statements and 22 PMs. Qualitative data supported justification for including three quality statements and one PM that achieved consensus slightly below a priori criteria. Three overarching themes emerged from the qualitative data related to quality statement actionability. Nine quality statements, nine structure PMs, and 14 process PMs are included in the final set, addressing four areas of delirium care: screening, diagnosis, risk reduction and management.
Conclusion. Results provide a contextualized set of guideline-based quality statements and PMs that are important, actionable, and necessary to a diverse group of clinical experts. The final set of quality statements from this study can be used to guide practice change and enhance standardized electronic documentation, and the PMs can provide baseline data to guide improvement efforts where they are most needed.