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Managing Delirium in the Emergency Department: An Updated Narrative Review.
April Ehrlich1, Esther S Oh1,2,3,4, Shaista Ahmed1
1Division of Geriatric Medicine and Gerontology, Department of Medicine, The Johns Hopkins University, 5200, Eastern Avenue, Suite , 2200 Baltimore, MD, 21224, USA.
Current Geriatrics Reports
|June 10, 2024
Summary
Emergency departments face a delirium epidemic, especially in older adults. This review identifies nine key components for effective delirium prevention and treatment programs in the ED, aiming for pragmatic and cost-effective solutions.
Area of Science:
- Geriatric Medicine
- Emergency Medicine
- Neuroscience
Background:
- Emergency departments (EDs) experience significant overcrowding and boarding, particularly affecting older adults who are prone to developing delirium.
- Delirium in the ED is linked to adverse outcomes, including increased complications, prolonged hospital stays, higher mortality rates, and elevated healthcare costs.
- Current strategies for preventing and treating delirium in the ED are limited in their pragmatic, sustainable, and cost-effective application.
Purpose of the Study:
- To conduct a narrative review of recent literature on delirium prevention and treatment programs specifically within the emergency department setting.
- To identify and describe the essential components of successful delirium management strategies that EDs can implement.
- To provide guidance for EDs in developing and establishing their own delirium management programs.
Main Methods:
- A narrative review of 10 studies published between 2005 and 2023 focusing on delirium interventions in the ED.
- Analysis of various intervention components reported in the selected studies.
- Synthesis of findings to identify common elements of effective delirium management.
Main Results:
- Nine core components of successful delirium prevention and treatment strategies in the ED were identified.
- Interventions studied include optimizing hemodynamics, oxygenation, pain management, hydration, nutrition, sleep, and sensory stimulation.
- Strategies also encompass avoiding certain medications (sedative hypnotics, antipsychotics, anticholinergics), limiting ED time, staff education, and integrating multidisciplinary protocols into EHRs.
Conclusions:
- Effective delirium management in the ED requires a multifaceted approach incorporating identified key components.
- Further high-quality research is needed to determine the most effective individual components of delirium prevention strategies.
- Prioritizing research in non-hip fracture populations is recommended for broader applicability.
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