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Center of Geriatric Nursing Excellence

Researching Efficient Approaches to Delirium Identification (READI)

Delirium is an acute change in cognitive function and may be expressed with symptoms that include inattention, disorganized thinking and sleep disturbance. Approximately half of all hospitalized older adults experience delirium, and it is costly. Delirium can lead to physical and mental decline, nursing home placement, and death, and it is estimated to cost the United States $164 billion annually. Supported by $2.4 million from the National Institute on Aging, this four-year interdisciplinary project, “Researching Efficient Approaches to Delirium Identification” (READI), aims to improve the care of older adults by developing an identification protocol to detect delirium in hospitalized adults age 70 and older.

Delirium Screening Tools

READI MPIs Dr. Donna Fick, RN and Dr. Ed Marcantonio, MD, developed and are currently testing a two-step protocol for identifying delirium in hospitalized older adults. The multi-site study is underway in Pennsylvania and Massachusetts (Mount Nittany Medical Center, State College and Beth Israel Deaconess Medical Center, Boston), with enrollments goals of 450 adults aged 70 and older and approximately 75 clinicians who administer the tools (including Physicians, Nurses, and Nursing Assistants). Study analysis for this aim will focus on measuring the feasibility and acceptance of the tool, time required, characteristics of the UB-2 (for all 3 disciplines) and the 2-step delirium identification protocol (for physicians and nurses), and its cost as performed by each discipline

Step-One: The UB-2

The Ultra-Brief 2-Item Screener (UB-2) is administered by the clinician first and consists of just two items: “please tell me the day of the week”, and “please tell me the months of the year backward, say December as your first month”. If the patient gets both items correct, the screen is negative for delirium and the assessment is over (in approximately 30 seconds). If possible, the clinician should document this in the health record so that they now have a baseline and can recognize a change in mental status if it occurs. If one or both items are incorrect (or they give no response or a nonsensical response), the clinician continues to step-two in the screening protocol, which involves administering the 3-minute Diagnostic Confusion Assessment Method (3D-CAM).

Early evidence for the UB-2 is promising; when administered correctly, the UB-2 has a sensitivity of 93% and specificity of 64%. Researchers created the following video to train and refresh clinicians on how to accurately deliver the tool.

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Step Two: The 3D-CAM

When a person fails to answer both questions on the UB-2 correctly, we follow-up with the 3-minute Diagnostic Confusion Assessment Method (3D-CAM). For information on the 3D-CAM and to explore other tools available for assessing delirium, visit the Hospital Elder Life Program (HELP).

This work was supported by the National Institute on Aging (NIA) (grants R01AG030618 and K24AG035075 [E.R.M.] and R24AG054259, P01AG031720, R01AG044518,  Dr. Fick is partially supported by the NIA (grant R01AG030618) and National Institute of Nursing Research (grant R01NR01104). The funding agencies had no role and the authors retained full autonomy in the preparation