title: Beyond grand rounds: a comprehensive and sequential intervention to improve identification of delirium.
abstract: OBJECTIVE
  Delirium is a widespread concern for hospitalized seniors, yet is often unrecognized. A comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium was tested.
  
  
  METHODS
  A 2-day CSI program that consisted of progressive 4-part didactic series, including evidence-based reviews of delirium recognition, prevention, and management, interspersed with interactive small group sessions and practical case conferences was conceptualized in consultation with a leading expert on delirium. Pretest and posttest instruments were designed to test the attendees on their knowledge and confidence around delirium identification.
  
  
  RESULTS
  An average of 71 people attended each didactic session. Among all responses, 50 pretests and posttests were matched based on numeric coding (6 MD/DOs, 34 RNs, and 10 others). Mean pretest and posttest scores were 7.9 and 10.8 points, respectively (maximum: 17), showing a positive change in knowledge scores after the intervention (2.9 points, p < .001). Improvement in knowledge scores was higher in the cohort attending 2 or more lectures (3.8 points, p < .001) compared with those attending only 1 lecture (1.3 points, p < .12). Confidence in identifying patients with delirium increased by 28% (p < .001), and self-assessed capacity to correctly administer the Confusion Assessment Method increased by 36% (p < .001).
  
  
  CONCLUSIONS
  A novel CSI increased clinician knowledge about delirium identification and management and improved confidence and self-assessed capacity to identify delirium in the hospitalized elderly patients. This strategy, which incorporates multiple reinforcing modes of education, may ultimately be more effective in influencing clinician behavior when compared with traditional grand rounds.
authors.affiliation: Family Medicine Residency Program, Underwood-Memorial Hospital, Woodbury, New Jersey 08096, USA. ravishankar.ramaswamy@gmail.com
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Ramaswamy
authors.forename: Edward F
authors.initials: EF
authors.lastname: Dix
authors.forename: Janet E
authors.initials: JE
authors.lastname: Drew
authors.forename: James J
authors.initials: JJ
authors.lastname: Diamond
authors.forename: Sharon K
authors.initials: SK
authors.lastname: Inouye
authors.forename: Barbara J O
authors.initials: BJ
authors.lastname: Roehl
mesh_terms: D015510:Clinical Medicine / Q000193:education*; D003693:Delirium / Q000175:diagnosis*; D004502:Education, Medical, Continuing / Q000379:methods*; D004521:Educational Measurement; D005194:Family Practice / Q000193:education; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D015397:Program Evaluation; D058996:Quality Improvement; D056164:Teaching Rounds