Pathway to Detection & Differentiation of Delirium & Dementia in the Emergency Department

Study Overview
=================
Brief Summary
-----------------
This is an observational study of the pragmatic implementation of an ED screening, outpatient referral, and care coordination process for older ED patients who may have UCID.

Detailed Description
-----------------
Embedded pragmatic, implementation pilot that incorporates training, ED assessment for delirium and dementia risk, referral of ED patients with undiagnosed cognitive impairment and dementia for primary care feedback and care recommendations. This pilot would gather observational data evaluating the feasibility of incorporating cognitive impairment screens into routine ED delirium assessments, and developing optimal work flow for identifying and referring ED patients with suspected (undiagnosed) dementia for confirmatory evaluation and care coordination.

Official Title
-----------------
Pathway to Detection & Differentiation of Delirium & Dementia in the Emergency Department

Conditions
-----------------
Cognitive Impairment, Emergency Care, Dementia, Delirium

Intervention / Treatment
-----------------
* Diagnostic Test: PD4ED 3-step intervention (ED assessment, outpatient assessment, Brain health plan)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Adults age 65 or older Discharged from the adult ED at YNHH or the ED at NMH Exclusion Criteria: Documented or known history of dementia Alcohol/substance intoxication while in the ED Non-English or Non-Spanish speaking

Ages Eligible for Study
-----------------
Minimum Age: 65 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ED delirium & dementia screening & outpatient referral<br>Routine ED screening for delirium and memory problems with referral for outpatient assessment of cognitive impairment. | Diagnostic Test: PD4ED 3-step intervention (ED assessment, outpatient assessment, Brain health plan)<br>* ED assessment for suspected dementia. positive ED patients referred for outpatient clinic cognitive impairment assessment. positive clinic patients referred to primary care with brain health patient plan.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Patients With Confirmed Delirium or Dementia | percentage of patients discharged from ED positive for delirium or dementia among total number of patients 65+ | 1 year | 
| Rates of Outpatient Assessment Referral of Patients With Suspected Dementia | number of patients with appointment to Alzheimer's Dementia Centers or geriatrics outpatient clinic / number of patients given information sheet or referred to outpatient clinic | 30 days | 
| Number of Participants Diagnosed With Dementia Among Those With Completed Outpatient Assessment | number of patients diagnosed with dementia (all categories) among those that completed the outpatient assessment | Up to 100 days from ED discharge | 
| Rates of Connection With Primary Care | number of patients with PCP follow-up about brain health plan of the number of patients with outpatient confirmation of Dementia or MCI | 30 days | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
delirium