title: The effect of a complementary e-learning course on implementation of a quality improvement project regarding care for elderly patients: a stepped wedge trial.
abstract: BACKGROUND
  Delirium occurs frequently in elderly hospitalised patients and is associated with higher mortality, increased length of hospital stay, functional decline, and admission to long-term care. Healthcare professionals frequently do not recognise delirium, indicating that education can play an important role in improving delirium care for hospitalised elderly. Previous studies have indicated that e-learning can provide an effective way of educating healthcare professionals and improving quality of care, though results are inconsistent.
  
  
  METHODS
  This stepped wedge cluster randomised trial will assess the effects of a complementary delirium e-learning course on the implementation of quality improvement initiative, which aims to enhance the recognition and management of delirium in elderly patients. The trial will be conducted in 18 Dutch hospitals and last 11 months. Measurements will be taken in all participating wards using monthly record reviews, in order to monitor delivered care. These measurements will include the percentage of elderly patients who were screened for the risk of developing delirium, use of the Delirium Observation Screening scale, use of nursing or medical interventions, and the percentage of elderly patients who were diagnosed with delirium. Data regarding the e-learning course will be gathered as well. These data will include user characteristics, information regarding use of the course, delirium knowledge before and after using the course, and the attitude and intentions of nurses concerning delirium care.
  
  
  METHODS
  The study will be conducted in internal medicine and surgical wards of eighteen hospitals that are at the beginning stages of implementing the Frail Elderly Project in the Netherlands.
  
  
  CONCLUSIONS
  Better recognition of elderly patients at risk for delirium and subsequent care is expected from the introduction of an e-learning course for nurses that is complementary to an existing quality improvement project. This trial has the potential to demonstrate that e-learning can be a vital part of the implementation process, especially for quality improvement projects aimed at complex health issues such as delirium. The study will contribute to a growing body of knowledge concerning e-learning and the effects it can have on knowledge as well as delivered care.
  
  
  BACKGROUND
  Netherlands Trial Register (NTR): NTR2885.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN Utrecht, The Netherlands. l.vandesteeg@nivel.nl
authors.forename: Lotte
authors.initials: L
authors.lastname: Van de Steeg
authors.forename: Maaike
authors.initials: M
authors.lastname: Langelaan
authors.forename: Roelie
authors.initials: R
authors.lastname: Ijkema
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003693:Delirium / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D020375:Education, Distance; D005260:Female; D016330:Frail Elderly; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands; D009740:Nursing Staff / Q000193:education*; D010348:Patient Care Team / Q000592:standards*; D058996:Quality Improvement; D013997:Time Factors; D016896:Treatment Outcome