The Barriers to Delirium Recognition and Assessment Among Critical Care Clinicians During the COVID-19 Pandemic
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The Barriers to Delirium Recognition and Assessment Among Critical Care Clinicians During the COVID-19 Pandemic


Background: Delirium is a persistent problem among critically ill, hospitalized patients. Up to80% of intensive care unit (ICU) patients might experience delirium, yet it is estimated that 75% of cases of delirium are missed. Delirium can result in multiple sequelae including long-term cognitive dysfunction and increased mortality risk. Delirium assessment and management methods are widely available; however, delirium remains an insidious consequence of critical illness and hospitalization. The COVID-19 global pandemic resulted in an increase in the rate of hospitalization of critically ill patients at risk for delirium. Past delirium research has been focused on physicians and nurses, but other clinicians who might encounter patients experiencing delirium have not yet provided their perspectives. There is limited understanding of the barriers to delirium recognition and assessment among critical care clinicians and the overall impact of the COVID-19 pandemic on these practices. Methods: This was a multi-methods project consisting of quantitative and qualitative studies. The quantitative arm of this study was a survey centered on the delirium recognition and assessment practices and barriers to these practices among critical care physicians, physical therapists (PTs), physical therapy aides (PTAs), registered nurses (RNs), and respiratory therapists (RTs). Summary statistics, Fisher’s exact test, and logistic regression were used to analyze responses and provide comparisons between clinician types. The qualitative arm of this study consisted of focus groups with PTs, RNs, and RTs. Sessions followed a semi-structured interview guide. Sessions were recorded, transcribed verbatim, and thematic analysis was utilized to develop themes. Results: One-hundred and fourteen clinicians responded to the survey. Most clinicians indicated that they used methods other than validated delirium assessment tools to evaluate for delirium. Delirium was viewed as a lower priority issue among clinicians and the COVID-19 pandemic further deprioritized delirium. A total of twelve clinicians participated in the focus group sessions. Participants indicated that delirium was perceived as a serious problem for patients, but was not a high priority to address. Lack of provider buy-in and inconsistent communication between clinicians were cited as barriers to consistent delirium recognition and assessment. The COVID-19 pandemic further exacerbated these barriers. Discussion: Participants of both studies indicated that delirium was viewed as a lower priority issue when weighed against other issues that patients might experience. The COVID-19 pandemic further deprioritized delirium recognition and assessment due to the severity of illness that patients were experiencing. Clinicians indicated that barriers to delirium recognition were not utilizing validated assessment tools, inconsistent communication, and lack of provider buy-in with regards to using validated methods. There were noted differences between health professions regarding delirium recognition and assessment practices. The findings of both studies indicated that clinicians could benefit from additional delirium education and the inclusion of additional clinicians in the process of delirium assessment. Additional research on the perspectives of delirium among critical care clinicians and the impact of the COVID-19 pandemic on delirium recognition and assessment is needed.

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