Critical Care: Critical Care - ICU Management |

Effectiveness of Educational Enhancement for Clinicians Regarding Understanding and Applying Confusion Assessment Method in the ICU (CAM-ICU) FREE TO VIEW

Tapan Pandya, MD; Michael Hanna, MD; Zeron Ghazarian, MD; Raminderjit Sekhon, MD; Mourad Ismail, MD
Author and Funding Information

New York Medical College/St. Joseph's Regional Medical Center, Paterson, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):222A. doi:10.1016/j.chest.2016.08.235
Text Size: A A A
Published online

SESSION TITLE: Critical Care - ICU Management

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Delirium is characterized by acute onset of fluctuating course of inattention accompanied by a change in cognition or perception. Delirium is one of the common end-organ dysfunction across hospital settings, occurring in up to 80% of critically ill patients that require ICU care. A patient who experiences delirium is more likely to experience increased short- and long-term mortality, increased time on ventilator and risk of re-intubation, increase in ICU and hospital length of stay. Since Delirium requires clinical diagnosis, it can easily be overlooked or missed. Development of reliable delirium-screening tools helps in early recognition of Delirium, allows clinicians to intervene on time and thus decreases morbidity and mortality.

METHODS: In an urban teaching hospital, CAM-ICU is being used as an assessment tool since January 2015. Incidence of Delirium in our ICU was found to be 19% which is significantly lower than nationally reported incidence. As a Quality Improvement project, a nine multiple-choice question survey was conducted amongst medical residents and fellows (clinicians), 2 of those questions were to see if clinicians knew what is the hallmark sign of delirium and if they were able to diagnose whether a patient has Delirium or not whereas third question was to check their comfort level for using CAM-ICU. The survey results emphasized the need for education to improve clinicians’ knowledge and ability to apply CAM-ICU at bedside. The study intervention was composed of education of clinicians about Delirium, and how to use CAM-ICU. Between January and March 2016, clinicians were educated about Delirium and CAM-ICU and a follow-up survey was conducted and results were compared to their previous performance. The primary end-point was to see an improvement in their percentage of correct response and comfort level of using CAM-ICU.

RESULTS: When asked for hallmark sign of Delirium, percentage of correct response in pre-education phase (n=35) was 34% which improved to 85% in post-education phase (n=20) which is statistically significant [proportion test, p-value = 0.0001 and C.I. (-0.7316311 - -0.2883689)]. For a sample case, percentage of correct response in pre-education phase was 40% which improved to 90% in post-education phase which is again statistically significant [proportion test, p-value = 0.0001 and C.I. (-0.708877 - -0.291123)]. Clinicians were also asked about their comfort level for using CAM-ICU and average score in pre-education phase was 3.74 out of 10 (1 = uncomfortable; 10 = comfortable) and post-education phase was 7.25 which is statistically significant [t-test, p-value < 0.0001 and C.I. (-4.58400 - -2.43029)].

CONCLUSIONS: Although clinicians are thought to have understanding of Delirium, their comfort level of recognizing Delirium and using CAM-ICU improved significantly when they received education and training in small groups and this improved the percentage of correct response significantly. Such educational interventions will be extremely helpful at recognizing Delirium and thus decreasing morbidity and mortality.

CLINICAL IMPLICATIONS: Frequent educational enhancement projects for Delirium and CAM-ICU are implemented in our ICU and such an approach can be extremely helpful for all ICUs.

DISCLOSURE: The following authors have nothing to disclose: Tapan Pandya, Michael Hanna, Zeron Ghazarian, Raminderjit Sekhon, Mourad Ismail

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543