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. 2013 May;22(3):257-62.
doi: 10.4037/ajcc2013447.

Clinical decision support system and incidence of delirium in cognitively impaired older adults transferred to intensive care

Babar A Khan  1 , Enrique Calvo-Ayala, Noll Campbell, Anthony Perkins, Ruxandra Ionescu, Jason Tricker, Tiffany Campbell, Mohammed Zawahiri, John D Buckley, Mark O Farber, Malaz A Boustani
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Clinical decision support system and incidence of delirium in cognitively impaired older adults transferred to intensive care

Babar A Khan et al. Am J Crit Care. 2013 May.

Abstract

Background: Elderly patients with cognitive impairment are at increased risk of developing delirium, especially in the intensive care unit.

Objective: To evaluate the efficacy of a computer-based clinical decision support system that recommends consulting a geriatrician and discontinuing use of urinary catheters, physical restraints, and unnecessary anticholinergic drugs in reducing the incidence of delirium.

Methods: Data for a subgroup of patients enrolled in a large clinical trial who were transferred to the intensive care units of a tertiary-care, urban public hospital in Indianapolis were analyzed. Data were collected on frequency of orders for consultation with a geriatrician; discontinuation of urinary catheterization, physical restraints, or anticholinergic drugs; and the incidence of delirium.

Results: The sample consisted of 60 adults with cognitive impairment. Mean age was 74.6 years; 45% were African American, and 52% were women. No differences were detected between the intervention and the control groups in orders for consultation with a geriatrician (33% vs 40%; P = .79) or for discontinuation of urinary catheters (72% vs 76%; P = .99), physical restraints (12% vs 0%; P=.47), or anticholinergic drugs (67% vs 36%; P=.37). The 2 groups did not differ in the incidence of delirium (27% vs 29%; P = .85).

Conclusion: Use of a computer-based clinical decision support system may not be effective in changing prescribing patterns or in decreasing the incidence of delirium.

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