title: Educational impact of a psychiatric liaison in the medical intensive care unit: effects on attitudes and beliefs of trainees and nurses regarding delirium.
abstract: OBJECTIVE
  Despite high rates and increased risk of mortality, delirium remains underdiagnosed and a minimal focus of formal medical education. This is the first study to examine the educational impact of a psychiatric liaison on beliefs and knowledge about delirium among both nurses and residents.
  
  
  METHODS
  One psychiatrist spent 9 months rounding weekly in the medical intensive care unit, interacting with critical care nurses and internal medicine residents. Preintervention and postintervention surveys were distributed in July 2009 and June 2010, respectively, to staff (critical care nurses: n = 23 and n = 25, respectively; internal medicine residents: n = 31 and n = 23, respectively) and a comparison group (psychiatry residents: n = 29 and n = 23, respectively). Participants responded to 12 statements regarding delirium on a 5-point Likert scale.
  
  
  RESULTS
  There were no statistically significant differences between the presurveys and postsurveys for any item when examining all respondents together, as well as psychiatry and internal medicine residents as individual groups. Critical care nurses showed a significant change between surveys for the statements, "Patients with new-onset anxiety or depression in the intensive care unit most commonly have delirium" (17.4% agree presurvey vs 56.0% agree postsurvey, χ(2) = 7.62, P = .006) and "Delirium is diagnosed less often than it actually occurs" (100% agree presurvey vs 80% agree postsurvey, χ(2) = 5.13, P = .023).
  
  
  CONCLUSIONS
  Though introduction of a psychiatric liaison was very well received by clinical staff, we did not meaningfully affect the attitudes and beliefs of trainees and nurses regarding delirium. Robust and lasting changes in attitudes regarding delirium may require more intensive efforts involving longer intervention periods, greater rounding frequency, or additional didactic teaching.
authors.affiliation: Harvard Medical School, Boston, Massachusetts (Drs Beach and Huffman); Department of Psychiatry, Massachusetts General Hospital, Boston (Drs Beach and Huffman); and the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville (Dr Chen).
authors.forename: Scott R
authors.initials: SR
authors.lastname: Beach
authors.forename: Donna T
authors.initials: DT
authors.lastname: Chen
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Huffman