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The study aimed to determine the efficacy of the ED Delirium Detection Program (ED\u2010DDP) to improve delirium detection while evaluating implementation outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The ED\u2010DDP consisted of a train\u2010the\u2010trainer model where delirium champions (DCs) trained ED nurses to perform delirium screening using an electronic health record (EHR)\u2010embedded Brief Confusion Assessment Method (bCAM). The ED\u2010DDP was implemented across 3 diverse EDs using a stepped\u2010wedge cluster randomized trial, consisting of control, implementation, and intervention periods. The RE\u2010AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework guided outcome assessments. Efficacy was defined as delirium detection between control and intervention periods. Implementation outcomes were assessed via quantitative (surveys, training logs, EHR) and qualitative (semi\u2010structured interviews) methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across the 3 ED sites, 94.4% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200917\/18) of DCs completed delirium training and 94.4% scored \u2265\u200980% on the post\u2010workshop assessment (Implementation\/Fidelity). Over 90% (91.1%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009195\/214) of nurses agreed to receive training by DCs (Adoption); the average score during nurse bCAM spot checks was 73.3% (Implementation\u2010Fidelity). After ED\u2010DDP implementation, the odds of delirium screening were 11.5 times higher (95% CI: [6.0, 22.3],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), when adjusting for time and site clustering (Penetration); screening varied from 6% to 80% across the 3 sites (Reach). The proportion of older adult encounters with a positive delirium screen increased from 0% to 2.2% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002; Efficacy). Qualitative data revealed that although DCs and nurses thought delirium screening was a priority for patient care quality and safety, competing priorities were a barrier to consistent and accurate screening (Maintenance).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although a comprehensive ED delirium training program successfully increased delirium screening, detection remained low. These findings suggest that sustainable delirium detection in the ED requires not only robust training but also deeply embedded workflow solutions and clear post\u2010detection action pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70235","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T11:40:46Z","timestamp":1770637246000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Improving Delirium Screening and Detection in the Emergency Department (\n                    <scp>ED<\/scp>\n                    ): The Implementation and Evaluation of the\n                    <scp>ED<\/scp>\n                    Delirium Detection Program"],"prefix":"10.1111","volume":"33","author":[{"given":"Liron","family":"Sinvani","sequence":"first","affiliation":[{"name":"Northwell Health  New Hyde Park New York USA"},{"name":"Donald and Barbara Zucker School of Medicine at 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