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A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes

Overview of attention for article published in Critical Care, December 2015
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (94th percentile)
  • High Attention Score compared to outputs of the same age and source (85th percentile)

Mentioned by

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1 policy source
twitter
48 tweeters

Citations

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182 Dimensions

Readers on

mendeley
450 Mendeley
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Title
A systematic review of implementation strategies for assessment, prevention, and management of ICU delirium and their effect on clinical outcomes
Published in
Critical Care, December 2015
DOI 10.1186/s13054-015-0886-9
Pubmed ID
Authors

Zoran Trogrlić, Mathieu van der Jagt, Jan Bakker, Michele C Balas, E Wesley Ely, Peter HJ van der Voort, Erwin Ista

Abstract

Despite recommendations from professional societies and patient safety organizations, the majority of ICU patients worldwide are not routinely monitored for delirium, thus preventing timely prevention and management. The purpose of this systematic review is to summarize what types of implementation strategies have been tested to improve ICU clinicians' ability to effectively assess, prevent and treat delirium and to evaluate the effect of these strategies on clinical outcomes. We searched PubMed, Embase, PsychINFO, Cochrane and CINAHL (January 2000 and April 2014) for studies on implementation strategies that included delirium-oriented interventions in adult ICU patients. Studies were suitable for inclusion if implementation strategies' efficacy, in terms of a clinical outcome, or process outcome was described. We included 21 studies, all including process measures, while 9 reported both process measures and clinical outcomes. Some individual strategies such as "audit and feedback" and "tailored interventions" may be important to establish clinical outcome improvements, but otherwise robust data on effectiveness of specific implementation strategies were scarce. Successful implementation interventions were frequently reported to change process measures, such as improvements in adherence to delirium screening with up to 92%, but relating process measures to outcome changes was generally not possible. In meta-analyses, reduced mortality and ICU length of stay reduction were statistically more likely with implementation programs that employed more (six or more) rather than less implementation strategies and when a framework was used that either integrated current evidence on pain, agitation and delirium management (PAD) or when a strategy of early awakening, breathing, delirium screening and early exercise (ABCDE bundle) was employed. Using implementation strategies aimed at organizational change, next to behavioural change ,was also associated with reduced mortality. Our findings may indicate that multi-component implementation programs with a higher number of strategies targeting ICU delirium assessment, prevention and treatment and integrated within PAD or ABCDE bundle have the potential to improve clinical outcomes. However, prospective confirmation of these findings is needed to inform the most effective implementation practice with regard to integrated delirium management and such research should clearly delineate effective practice change from improvements in clinical outcomes.

Twitter Demographics

The data shown below were collected from the profiles of 48 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 450 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Spain 1 <1%
Mexico 1 <1%
Brazil 1 <1%
Unknown 447 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 81 18%
Other 48 11%
Student > Bachelor 42 9%
Researcher 41 9%
Student > Ph. D. Student 36 8%
Other 119 26%
Unknown 83 18%
Readers by discipline Count As %
Medicine and Dentistry 173 38%
Nursing and Health Professions 105 23%
Unspecified 12 3%
Psychology 11 2%
Agricultural and Biological Sciences 7 2%
Other 45 10%
Unknown 97 22%

Attention Score in Context

This research output has an Altmetric Attention Score of 31. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 17 March 2021.
All research outputs
#1,089,085
of 22,797,621 outputs
Outputs from Critical Care
#948
of 6,047 outputs
Outputs of similar age
#20,265
of 387,395 outputs
Outputs of similar age from Critical Care
#82
of 575 outputs
Altmetric has tracked 22,797,621 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 95th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 6,047 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 19.2. This one has done well, scoring higher than 84% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 387,395 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 94% of its contemporaries.
We're also able to compare this research output to 575 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 85% of its contemporaries.