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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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  • In the top 25% 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 (84th percentile)

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1 policy source
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45 X users

Citations

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220 Dimensions

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466 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.

X Demographics

X Demographics

The data shown below were collected from the profiles of 45 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 466 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 463 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 80 17%
Other 46 10%
Student > Bachelor 44 9%
Researcher 41 9%
Student > Ph. D. Student 36 8%
Other 109 23%
Unknown 110 24%
Readers by discipline Count As %
Medicine and Dentistry 172 37%
Nursing and Health Professions 106 23%
Psychology 10 2%
Agricultural and Biological Sciences 7 2%
Pharmacology, Toxicology and Pharmaceutical Science 7 2%
Other 43 9%
Unknown 121 26%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 29. 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 10 January 2024.
All research outputs
#1,339,165
of 25,394,764 outputs
Outputs from Critical Care
#1,147
of 6,558 outputs
Outputs of similar age
#22,229
of 395,593 outputs
Outputs of similar age from Critical Care
#70
of 466 outputs
Altmetric has tracked 25,394,764 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 94th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 6,558 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.8. This one has done well, scoring higher than 82% 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 395,593 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 466 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 84% of its contemporaries.