Pathway to Detection & Differentiation of Delirium & Dementia in the Emergency Department

Completed

• Conditions: Dementia; Emergency Care; Delirium; Cognitive Impairment
• Interventions: Diagnostic Test: PD4ED 3-step intervention (ED assessment, outpatient assessment, Brain health plan)

• Registration Number: NCT04846322
• Lead Sponsor: Yale University

Brief Summary

This is an observational study of the pragmatic implementation of an ED screening, outpatient referral, and care coordination process for older ED patients who may have UCID.

Detailed Description

Embedded pragmatic, implementation pilot that incorporates training, ED assessment for delirium and dementia risk, referral of ED patients with undiagnosed cognitive impairment and dementia for primary care feedback and care recommendations. This pilot would gather observational data evaluating the feasibility of incorporating cognitive impairment screens into routine ED delirium assessments, and developing optimal work flow for identifying and referring ED patients with suspected (undiagnosed) dementia for confirmatory evaluation and care coordination.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study Start: 2021-03-01
• Study First Submitted: 2021-03-25
• Study First Submitted QC: 2021-04-14
• Study First Posted: 2021-04-15
• Primary Completion: 2022-08-15
• Study Completion: 2022-08-15
• Results First Submitted: 2023-08-09
• Results First Submitted QC: 2023-09-27
• Results First Posted: 2023-10-23
• Status Verified: 2024-02
• Last Update Submitted: 2024-02-13
• Last Update Posted: 2024-03-07

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

• Adults age 65 or older
• Discharged from the adult ED at YNHH or the ED at NMH

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Exclusion Criteria

• Documented or known history of dementia
• Alcohol/substance intoxication while in the ED
• Non-English or Non-Spanish speaking

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
ED delirium & dementia screening & outpatient referral	PD4ED 3-step intervention (ED assessment, outpatient assessment, Brain health plan)	Routine ED screening for delirium and memory problems with referral for outpatient assessment of cognitive impairment.

Primary Outcome Measures

Name	Time	Method
Rates of Connection With Primary Care	30 days	number of patients with PCP follow-up about brain health plan of the number of patients with outpatient confirmation of Dementia or MCI
Percentage of Patients With Confirmed Delirium or Dementia	1 year	percentage of patients discharged from ED positive for delirium or dementia among total number of patients 65+
Rates of Outpatient Assessment Referral of Patients With Suspected Dementia	30 days	number of patients with appointment to Alzheimer's Dementia Centers or geriatrics outpatient clinic / number of patients given information sheet or referred to outpatient clinic
Number of Participants Diagnosed With Dementia Among Those With Completed Outpatient Assessment	Up to 100 days from ED discharge	number of patients diagnosed with dementia (all categories) among those that completed the outpatient assessment

Trial Locations

Locations (2)

Northwestern; 🇺🇸 Chicago, Illinois, United States

Yale New Haven Hospital; 🇺🇸 New Haven, Connecticut, United States