An exploration of the usability of two delirium screening tools in Epworth Richmond ICU; a pilot study.

Abstract

Background: Delirium is common in hospitalised patients, particularly those admitted to an intensive care unit (ICU). Early identification and management of delirium risk factors is an Australian clinical care standard. Aim: To evaluate the feasibility of delirium screening into the ICU, and compare the diagnostic accuracy of two screening tools; the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC). Methods: A multiple methods design was used. (1) The diagnostic accuracy of each screening tool to identify patients with delirium in ICU was evaluated against a physician documented diagnosis of delirium as the gold standard for diagnosis. (2) Focus group discussions were conducted to explore staff members’ perceptions of the usability of the tools and feasibility of introducing delirium screening in the ICU. Results: Clinical assessment of delirium was conducted on 66 patients, mean age 66 (SD 14) years. Seventeen patients (25.8%) scored positive for delirium during their ICU admission. The predictive accuracy of the CAM-ICU versus ICDSC tools was compared using receiver operating characteristics (ROC) curve analysis: CAM-ICU tool AUC ROC 0.74 (95%CI, 0.60 to 0.89) and ICDSC AUC ROC 0.82 (95%CI, 0.68 to 0.95), chi2 = 2.05, p = .153). Topics explored during the focus groups included: screening and assessment, nurse-led initiatives to manage delirium, escalation of care and usability of the screening tools. Conclusion: One in four patients screened in positive for possible delirium using the screening tools. Routine delirium screening is feasible, and will assist with detecting delirium in the ICU.