UNIVERSITY PARK, Pa. — To combat gaps in care and provide an easy-to-use tool for screening delirium, researchers in the Ross and Carol Nese College of Nursing and the Harvard Medical School developed a two-step screening process that supports quick detection and is now delivered through an Apple iPhone app that will be released this year.

The onset of delirium is typically fast moving and often without a singular cause, making screening, diagnosing, and treating difficult. Delirium is an acute, sudden, and reversible change in one’s mental state and those affected often become disoriented and experience reduced awareness, confusion, and behavioral or emotional changes. Recovery is highly dependent on detecting it and then treatment that moves equally as fast as the impairment’s onset.

Challenges in detection are multi-faceted, including time, overlapping features, lack of confidence in delirium tools, and under appreciation of delirium as a medical emergency. The outcomes associated with delirium are poor including increased costs, decline in functioning, nursing home placement, suffering, and death.

The newly released app is based on the group’s previous research that resulted in the Ultra-Brief 2-Item Screener (UB-2) and the 3-minute Diagnostic Confusion Assessment Method (3D-CAM), both of which comprise the two steps of the screening tool. In step one, a clinician can use the UB-2 to ask a patient two questions that will determine if utilizing the 3D-CAM, or step two, is warranted. Moving these tools to an app-delivered format, makes their usage even easier and enables quick detection and treatment.

The researchers in the Ross and Carol Nese College of Nursing include Donna Fick, Elouise Ross Eberly Professor and director of the Center of Geriatric Nursing Excellence; Marie Boltz, Elouise Ross Eberly and Robert Eberly Endowed Chair and professor; and Erica Husser, project director at Age-Friendly Care, PA; with Dr. Edward R. Marcantonio, section chief for research in the Division of General Medicine at BIDMC and professor of medicine at Harvard Medical School. Clinicians ranging from physician hospitalists, nurses and certified nursing assistants, deployed the app in two hospital settings: Mount Nittany Medical Center in Centre County, Pennsylvania, the teaching hospital associated with Penn State’s Ross and Carol Nese College of Nursing; and Beth Israel Deaconess Medical Center, in Boston, Massachusetts, a teaching hospital associated with Harvard Medical School.

“While numerous delirium screening tools have been developed and some have been integrated into electronic health systems, few studies have tested their use by clinicians,” said Edward R. Marcantonio. “Our study demonstrated that all three disciplines were able to complete the app-directed delirium detection protocol over 97% of the time. The protocol took an average of less than 1½ minutes to complete, with an overall accuracy rate of 89%.”

Adequate screening is step one in managing the impacts of delirium; with highly effective and easy-to-use tools, recovering from delirium becomes more likely. To learn more about the researchers’ approach to testing their tool, visit the Annals of Internal Medicine.