Delirium is associated with increased morbidity, mortality, and healthcare costs. Despite best practice guidelines recommending non-pharmacological treatment strategies, delirium is frequently sub-optimally managed with reliance on antipsychotics or benzodiazepines. To optimize delirium management at our institution, we implemented a clinical decision support tool embedded within our Epic electronic medical record (EMR). Our team developed an Our Practice Advisory (OPA) triggered by a positive delirium screening result to alert hospitalists to patients at high risk for delirium. An accompanying order set emphasized high-value management, such as frequent re-orientation, and de-emphasized antipsychotics through embedded education and “collapsing” the antipsychotic section by default upon opening the order set. Mechanical restraint options were also intentionally excluded from the order set. We conducted a quasi-experimental pre-post study (December 2023 - November 2024), across two hospitals, measuring medication use, restraint use, bowel regimen orders, and provider engagement. Restraint use decreased significantly (35.4% to 23.4%, p<0.001). Antipsychotic and bowel regimen use showed no improvement. Provider engagement with the order set was robust, with 76.4% of providers reviewing the order set and 40.7% placing orders. This study demonstrates that EMR-embedded clinical decision support tools can influence clinician behavior and encourage concordance with evidence-based guidelines for delirium management. Additional refinements are needed to further promote provider adherence and translate changes in provider behavior into improvements in patient outcomes.
Ji et al. (Wed,) studied this question.