Improving delirium detection in intensive care units: Multicomponent education and training program

J Am Geriatr Soc. 2021 Nov;69(11):3249-3257. doi: 10.1111/jgs.17419. Epub 2021 Aug 16.


Background: Delirium is a common, devastating, and underrecognized syndrome in the intensive care unit (ICU). The study aimed to describe and evaluate a multicomponent education and training program utilizing a "Train-The-Trainer" (TTT) model, to improve delirium detection across a large health system.

Methods: Fourteen ICUs across nine hospitals participated in a multicomponent delirium program consisting of a 1-day workshop that included: (1) patient testimonials, (2) small group discussions, (3) didactics, and (4) role-playing. Additionally, four ICUs received direct observation/training via telehealth (tele-delirium training). The Kirkpatrick model was used for program evaluation in a pre/post-test design.

Results: A 1-day delirium workshop was held at two time points and included 73 ICU nurses. Of the 65 nurses completing the post-workshop satisfaction survey, most (46.2) had >10 years of clinical experience, and no or minimal delirium training (69.2%). All nurses (100%) identified lack of knowledge as a barrier to delirium detection, while time constraints and lack of importance accounted for only 25%. Overall, nurses rated the workshop positively (excellent 66.7%, and very good 23.3%), and likely to change practice (definitely 73.3% and very likely 15.0%). All validated Confusion Assessment Method for the ICU (CAM-ICU) cases demonstrated improvement in number of correct responses. Delirium detection across the health system improved from 9.1% at baseline to 21.2% in ICUs that participated in the workshop and 30.1% in those ICUs that also participated in the tele-delirium training (p = 0.005).

Conclusion: A multicomponent delirium education and training program using a TTT model was rated positively, improved CAM-ICU knowledge, and increased delirium detection.

Keywords: critical care nursing; delirium; intensive care units; telemedicine.

MeSH terms

  • Delirium / diagnosis*
  • Educational Status
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Nursing Assessment / standards*
  • Nursing Staff, Hospital / education*
  • Program Evaluation / statistics & numerical data
  • Role Playing
  • Surveys and Questionnaires
  • Teaching*