SHM Converge Scientific Abstract ePoster Gallery-Development of Clinical Decision Support for High-Value Inpatient Delirium Management

Pdf Summary

This project developed and piloted an Epic EMR-embedded clinical decision support tool to improve inpatient delirium management in older adults. The team created a Best Practice Advisory (BPA) that triggered when a patient screened positive for delirium on the 4AT and linked it to a Delirium Prevention and Management order set. The order set was designed using a literature review, feedback from a multidisciplinary Delirium Taskforce, and team discussion, with emphasis on high-value interventions such as frequent re-orientation rather than routine antipsychotic or restraint use.<br /><br />The pilot was conducted on a 160-bed unit over a 6-week pre-intervention period and a 22-week post-intervention period in patients aged 65 and older. Data were extracted from the Epic EMR, and process measures were compared before and after implementation.<br /><br />Patient characteristics were similar across the two periods. Of 320 BPA activations, 128 (37%) led to providers placing new orders through the order set. During the pilot, restraint use declined from 32.7% pre-intervention to 22.0% post-intervention, a statistically significant reduction (p=0.014), representing an 11% decline overall. Antipsychotic use did not change significantly, and bowel regimen use remained stable.<br /><br />Overall, the BPA and order set were associated with improved delirium care processes, particularly reduced restraint use, though run chart analysis showed the temporal effect was less clear. The authors plan iterative refinement of the decision support tool, continued monitoring of process measures, and expansion to additional units.

Asset Subtitle

Caleb Murphy

Meta Tag

Author List Caleb Murphy, Lauren Gleason, Nora Spadoni, Patricia Lee, Robin Ji

Category Research

Concept EMR-Based Decision Support

Concept Delirium Management

Concept Best Practice Advisory

Concept 4 As Test

Concept Delirium prevention order set

Distinguished Non-Finalist

Presenter Organization Northwestern University Feinberg School of Medicine

Presenting Author Caleb Murphy

Track Value in Hospital Medicine

Keywords

Epic EMR

clinical decision support

delirium management

older adults

Best Practice Advisory

4AT screening

order set

restraint reduction

antipsychotic use

inpatient pilot

EMR-Based Decision Support

Delirium Management

Best Practice Advisory

4 As Test

Delirium prevention order set