Clinical decision support system and incidence of delirium in cognitively impaired older adults transferred to intensive care

Babar A. Khan, Enrique Calvo-Ayala, Noll Campbell, Anthony Perkins, Ruxandra Ionescu, Jason Tricker, Tiffany Campbell, Mohammed Zawahiri, John D. Buckley, Mark O. Farber, Malaz A. Boustani

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Background: Elderly patients with cognitive impairment are at increased risk of developing delirium, especially in the intensive care unit. Objective: To evaluate the efficacy of a computer-based clinical decision support system that recommends consulting a geriatrician and discontinuing use of urinary catheters, physical restraints, and unnecessary anticholinergic drugs in reducing the incidence of delirium. Methods: Data for a subgroup of patients enrolled in a large clinical trial who were transferred to the intensive care units of a tertiary-care, urban public hospital in Indianapolis were analyzed. Data were collected on frequency of orders for consultation with a geriatrician; discontinuation of urinary catheterization, physical restraints, or anticholinergic drugs; and the incidence of delirium. Results: The sample consisted of 60 adults with cognitive impairment. Mean age was 74.6 years; 45% were African American, and 52% were women. No differences were detected between the intervention and the control groups in orders for consultation with a geriatrician (33% vs 40%; P = .79) or for discontinuation of urinary catheters (72% vs 76%; P = .99), physical restraints (12% vs 0%; P=.47), or anticholinergic drugs (67% vs 36%; P=.37). The 2 groups did not differ in the incidence of delirium (27% vs 29%; P = .85). Conclusion: Use of a computer-based clinical decision support system may not be effective in changing prescribing patterns or in decreasing the incidence of delirium. (American Journal of Critical Care. 2013;22:257-262).

Original languageEnglish (US)
Pages (from-to)257-262
Number of pages6
JournalAmerican Journal of Critical Care
Volume22
Issue number3
DOIs
StatePublished - May 1 2013

ASJC Scopus subject areas

  • Critical Care

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    Khan, B. A., Calvo-Ayala, E., Campbell, N., Perkins, A., Ionescu, R., Tricker, J., Campbell, T., Zawahiri, M., Buckley, J. D., Farber, M. O., & Boustani, M. A. (2013). Clinical decision support system and incidence of delirium in cognitively impaired older adults transferred to intensive care. American Journal of Critical Care, 22(3), 257-262. https://doi.org/10.4037/ajcc2013447