Closing the Gap Between Risk and Recognition: Improving Delirium Screening in the Pediatric Intensive Care Unit

Delirium occurs in 20%-40% of pediatric intensive care unit (PICU) patients and is associated with increased morbidity, mortality, healthcare expenditure, and long-term psychological consequences. Despite the implementation of delirium screening in the Children's Hospital Colorado PICU in 2019 using the Cornell Assessment of Pediatric Delirium (CAPD) screening tool, screening compliance remained <50%. This project aimed to improve delirium screening compliance in the Children's Hospital Colorado PICU from 48% of scoring opportunities to 80% over 13 months.

This quality improvement initiative was conducted in a 48-bed quaternary PICU and included 4,195 patients admitted from April 2024 to April 2025. We developed key driver diagrams and process maps using nursing surveys and workflow insights. Interventions included electronic health record embedded CAPD reminders, multidisciplinary delirium and CAPD tool education, and dissemination of a departmental delirium clinical practice resource. We extracted data from an internally developed and validated electronic health record delirium dashboard. We used statistical process control charts to evaluate outcomes.

CAPD scoring compliance increased from a baseline of 48.0% to 75.9% following interventions. Positive delirium screening rates decreased from 54.6% to 44.3%. Postintervention nursing surveys showed that 100% of respondents reported a neutral or positive impact on workflow, and the proportion citing lack of reminders as a barrier decreased from 41% to less than 10%.

A multidisciplinary, workflow-integrated approach substantially improved CAPD screening compliance in a high-volume, high-acuity PICU. Electronic health record-embedded reminders and targeted education are low-cost strategies for improving delirium screening adherence without increasing perceived nursing workload.