Reducing Low-Value Delirium Care Using Behavioral Design in the Electronic Medical Record

Area of Science:

• Clinical Informatics
• Geriatric Medicine
• Patient Safety

Background:

• Delirium is a common, serious condition linked to poor patient outcomes and high costs.
• Current delirium management often deviates from evidence-based guidelines, over-relying on pharmacological interventions.
• Optimizing delirium care requires effective strategies to promote guideline-adherent practices.

Purpose of the Study:

• To evaluate the impact of an electronic medical record (EMR)-embedded clinical decision support tool on delirium management.
• To assess changes in medication use, restraint use, and provider engagement following implementation.
• To determine the effectiveness of a novel intervention in promoting evidence-based delirium care.

Main Methods:

• A quasi-experimental pre-post study was conducted across two hospitals.
• An Our Practice Advisory (OPA) within the EMR alerted providers to high-risk delirium patients.
• The intervention included an order set emphasizing non-pharmacological strategies and de-emphasizing antipsychotics and restraints.

Main Results:

• Mechanical restraint use decreased significantly from 35.4% to 23.4% (p<0.001).
• No significant improvement was observed in antipsychotic or bowel regimen ordering.
• Provider engagement was high, with 76.4% reviewing the order set and 40.7% placing orders.

Conclusions:

• EMR-embedded clinical decision support tools can effectively modify clinician behavior regarding restraint use in delirium.
• Further refinements are necessary to improve adherence to all evidence-based guidelines and achieve better patient outcomes.
• Targeted interventions can promote concordance with best practices for delirium management.