ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased...

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Page 1: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓
Page 2: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Page 3: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Page 4: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Page 5: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Page 6: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Phase I: Is there anImplementation-Problem?

Phase I: Is there anImplementation-Problem?

Page 7: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Page 8: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Page 9: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Perfectamundo?Perfectamundo?

Page 10: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Perfectamundo?Perfectamundo?

Page 11: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

ImIm-Perfectamundo!-Perfectamundo!

Page 12: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Page 13: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Page 14: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Page 15: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Phase I: Is there anImplementation-Problem

Phase I: Is there anImplementation-Problem

Page 16: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Phase I: Is there anImplementation-Problem: YES!?

Phase I: Is there anImplementation-Problem: YES!?

Page 17: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Page 18: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Phase II: Effects ofImplementation

Phase II: Effects ofImplementation

Page 19: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuidelineBarrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Page 20: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuidelineBarrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Page 21: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Page 22: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

1.Current Practices1.Current Practices

2.Survey and Focusgroup 2.Survey and Focusgroup interviewsinterviews

3.Development and Description of a Tailored 3.Development and Description of a Tailored Implementation Strategy for an ICU Delirium Implementation Strategy for an ICU Delirium

GuidelineGuidelineEffects of Improved Adherence Effects of Improved Adherence

to Guideline (Before-After to Guideline (Before-After Design)?Design)?

✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Page 23: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

ICU Delirium is a clinically relevant ICU Delirium is a clinically relevant form of Organ Dysfunction in the form of Organ Dysfunction in the

Critically IllCritically Ill✓Increased Increased mortalitymortality✓Increased Increased LOS at ICULOS at ICU✓Increased Increased costscosts✓Possibly increased Possibly increased complication ratecomplication rate

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Implementation of Dutch Implementation of Dutch ICU Delirium GuidelineICU Delirium Guideline

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Adherence to Dutch Adherence to Dutch ICU Delirium Guideline?ICU Delirium Guideline?

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

Dutch ICU Delirium Dutch ICU Delirium GuidelineGuideline

Prevention, Screening, TreatmentPrevention, Screening, Treatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

AimAim✓Improved Outcome after ICU Improved Outcome after ICU treatmenttreatment

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Center-Tailored Center-Tailored Implementation of Implementation of

GuidelineGuideline

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

Barrier-and-Barrier-and-Facilitator AnalysisFacilitator Analysis

1.Current Practices1.Current Practices

2.Survey and Focusgroup 2.Survey and Focusgroup interviewsinterviews

3.Development and Description of a Tailored 3.Development and Description of a Tailored Implementation Strategy for an ICU Delirium Implementation Strategy for an ICU Delirium

GuidelineGuideline

5.Cost-effectiveness of a 5.Cost-effectiveness of a Tailored Implementation of Tailored Implementation of

an ICUan ICUDelirium GuidelineDelirium Guideline

4.Effect of a Tailored Implementation of an 4.Effect of a Tailored Implementation of an ICUICU

Delirium Guideline on Complications and Delirium Guideline on Complications and MortalityMortality

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Effects of Improved Adherence Effects of Improved Adherence to Guideline (Before-After to Guideline (Before-After

Design)?Design)?✓Mortality?Mortality?✓LOS at ICU?LOS at ICU?✓Costs?Costs?✓Complications?Complications?✓Delirium Incidence?Delirium Incidence?

Page 24: ICU Delirium is a clinically relevant form of Organ Dysfunction in the Critically Ill ✓ Increased mortality ✓ Increased LOS at ICU ✓ Increased costs ✓

Management of Delirium - Management of Delirium Final - 2.pdfHypoactive Delirium • Study of 300 ED patients >65y at Vanderbilt, all screened for delirium by CAM-ICU • 8.3% had

Management of Delirium - Management of Delirium Final - 2.pdfHypoactive Delirium • Study of 300 ED patients >65y at Vanderbilt, all screened for delirium by CAM-ICU • 8.3% had

Preventing ICU Subsyndromal Delirium Conversion …...Preventing ICU Subsyndromal Delirium Conversion to Delirium With Low-Dose IV Haloperidol:A Double-Blind, Placebo-Controlled Pilot

Preventing ICU Subsyndromal Delirium Conversion …...Preventing ICU Subsyndromal Delirium Conversion to Delirium With Low-Dose IV Haloperidol:A Double-Blind, Placebo-Controlled Pilot

DELIRIUM Lindsay Trantum ACNP-BC VUMC Neuroscience ICU.

DELIRIUM Lindsay Trantum ACNP-BC VUMC Neuroscience ICU.

Sleep & Delirium in the ICU: What is the Relationship? · Sleep & Delirium in the ICU: What is the Relationship? Karen J. Bosma, MD, FRCPC Associate Professor, Department of Medicine,

Sleep & Delirium in the ICU: What is the Relationship? · Sleep & Delirium in the ICU: What is the Relationship? Karen J. Bosma, MD, FRCPC Associate Professor, Department of Medicine,

Delirium in ICU Characteristic, Diagnosis and Prevention

Delirium in ICU Characteristic, Diagnosis and Prevention

ICU Pain, Agitation, and Delirium Care Bundle

ICU Pain, Agitation, and Delirium Care Bundle

Acquired Delirium Occupational Therapy Impacting ICU · Delirium ICU syndrome chosis cute brain failure hysteria Metabolic derangement Acute confusional state. Who is more at risk

Acquired Delirium Occupational Therapy Impacting ICU · Delirium ICU syndrome chosis cute brain failure hysteria Metabolic derangement Acute confusional state. Who is more at risk

Patients Gone Wild: Agitation and Delirium in the ICU

Patients Gone Wild: Agitation and Delirium in the ICU

Delirium Prevention and Treatment: Current Evidence Gaps · • Cohort studies suggest patient’s taking a statin at the time of ICU admission have reduced ICU delirium Page VJ et

Delirium Prevention and Treatment: Current Evidence Gaps · • Cohort studies suggest patient’s taking a statin at the time of ICU admission have reduced ICU delirium Page VJ et

Medicine Hat Regional Hospital ICU Delirium Collaborative.

Medicine Hat Regional Hospital ICU Delirium Collaborative.

CAM-ICU Basics ICU Delirium and Cognitive Impairment Study Group delirium@vanderbilt.edu.

CAM-ICU Basics ICU Delirium and Cognitive Impairment Study Group [email protected].

Delirium in the ICU - Pitt · Subsyndromal delirium • Pts that fall short of the diagnos_c threshold for delirium (ICDSC ≥ 4) • ICU paents without delirium compared to those

Delirium in the ICU - Pitt · Subsyndromal delirium • Pts that fall short of the diagnos_c threshold for delirium (ICDSC ≥ 4) • ICU paents without delirium compared to those

Delirium in the ICU · CCPOT (see handout) CCPOT Posi_ve (score >2) Treat pain Reassess CCPOT. Did score decrease? S_ll not directable 3. Delirium Assessment CAM-ICU (see handout)

Delirium in the ICU · CCPOT (see handout) CCPOT Posi_ve (score >2) Treat pain Reassess CCPOT. Did score decrease? S_ll not directable 3. Delirium Assessment CAM-ICU (see handout)

Delirium in ICU -By Dr.Tinku Joseph

Delirium in ICU -By Dr.Tinku Joseph

ICU Trends: what does that mean to the SLP across the ... Fall Conference/Speaker...ICU Delirium is a predictor of •Increased mortality •Increased Length of Stay •Increased time

ICU Trends: what does that mean to the SLP across the ... Fall Conference/Speaker...ICU Delirium is a predictor of •Increased mortality •Increased Length of Stay •Increased time

ADULT ICU DELIRIUM UPDATE...Before/after (notification) 652 Duration of ICU and Delirium and mortality No Diff Reade Crit Care Resusc 2011 Before/after (CAM use) 288 RN documentation

ADULT ICU DELIRIUM UPDATE...Before/after (notification) 652 Duration of ICU and Delirium and mortality No Diff Reade Crit Care Resusc 2011 Before/after (CAM use) 288 RN documentation

ICU Delirium and Its Relation to Occupational Performance 121… · ICU Delirium and Its Relation to Occupational Performance Vi Nguyen, OTR, BSRC, MOT Rebecca Chan, OTR, MOT. Objectives

ICU Delirium and Its Relation to Occupational Performance 121… · ICU Delirium and Its Relation to Occupational Performance Vi Nguyen, OTR, BSRC, MOT Rebecca Chan, OTR, MOT. Objectives

Delirium in the ICU - Amazon S3 · 2016-11-30 · Delirium in the ICU is not obvious Clinicians routine exam miss 75% of delirium Current tools lack sensitivity Inter-rater reliability

Delirium in the ICU - Amazon S3 · 2016-11-30 · Delirium in the ICU is not obvious Clinicians routine exam miss 75% of delirium Current tools lack sensitivity Inter-rater reliability

Can We Prevent Delirium in the ICU? - UCSF CME - Maze...Can We Prevent Delirium in the ICU? Dr Mervyn Maze MB ChB, FRCP, ... – Dexmedetomidine patented for sedative- ... • Hypnotics

Can We Prevent Delirium in the ICU? - UCSF CME - Maze...Can We Prevent Delirium in the ICU? Dr Mervyn Maze MB ChB, FRCP, ... – Dexmedetomidine patented for sedative- ... • Hypnotics

Delirium and Long-Term Cognitive Impairment in ICU … · Delirium and Long-Term Cognitive Impairment in ICU Survivors . Disclosures: ... Other 37 38 Mechanically ventilated Patients,

Delirium and Long-Term Cognitive Impairment in ICU … · Delirium and Long-Term Cognitive Impairment in ICU Survivors . Disclosures: ... Other 37 38 Mechanically ventilated Patients,