{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:35:19Z","timestamp":1788870919987,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2014,4,18]],"date-time":"2014-04-18T00:00:00Z","timestamp":1397779200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Reynolds Foundation"},{"name":"Geriatric Academic Career Award","award":["KO1HP20494-02-00"],"award-info":[{"award-number":["KO1HP20494-02-00"]}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"crossref","award":["K24 AG035075"],"award-info":[{"award-number":["K24 AG035075"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine whether a bundled intervention can increase detection of delirium and facilitate safer use of high\u2010risk medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Pre\u2010post interventional trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Large academic medical center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Individuals aged 70 and older (n = 19,949) admitted between May 1, 2008, September 30, 2011. Individuals aged 80 and older admitted after April 26, 2010, received the intervention, those aged 80 and older admitted before were primary controls, and those aged 70 to 79 were concurrent controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>The intervention uses a checklist promoting delirium prevention, recognition and management, and modifies the computerized provider order entry system to provide care focused on elderly adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>\n                      Frequency of orders for activating the rapid response team for altered mental status, frequency of orders for haloperidol in excess of 0.5\u00a0mg or intravenous (\n                      <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n                      ) morphine in excess of 2\u00a0mg, and discharge disposition.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Participants receiving the intervention had a mean age of 86.1\u00a0\u00b1\u00a04.6; 58.2% were female. The number of orders to activate the rapid response team for altered mental status increased in participants receiving the bundle and in controls (odds ratio (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      ) for the difference of differences\u00a0=\u00a01.23 (95% confidence interval (\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      )\u00a0=\u00a00.68\u20132.24,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.49)). Participants receiving the bundle were less likely to receive more than 0.5\u00a0mg of\n                      <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n                      , intramuscular, or oral haloperidol (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      \u00a0=\u00a00.60, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      \u00a0=\u00a00.39\u20130.91,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.02) and more than 2\u00a0mg of\n                      <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>\n                      morphine (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      \u00a0=\u00a00.52, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      \u00a0=\u00a00.42\u20130.63,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Participants who received the bundle were more likely to be discharged home than to extended care facilities (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      \u00a0=\u00a01.18, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      \u00a0=\u00a01.04\u20131.35,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An intervention focused on delirium prevention and recognition by bedside staff combined with computerized decision support facilitates safer prescribing of high\u2010risk medications and possibly results in less need for extended care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.12780","type":"journal-article","created":{"date-parts":[[2014,4,19]],"date-time":"2014-04-19T06:23:26Z","timestamp":1397888606000},"page":"936-942","source":"Crossref","is-referenced-by-count":13,"title":["A Standardized, Bundled Approach to Providing Geriatric\u2010Focused Acute Care"],"prefix":"10.1111","volume":"62","author":[{"given":"Melissa L. P.","family":"Mattison","sequence":"first","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Division of Gerontology Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Division of General Medicine and Primary Care Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Catic","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Division of Gerontology Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger B.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Division of General Medicine and Primary Care Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Olveczky","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Division of General Medicine and Primary Care Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Moran","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Division of Gerontology Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Division of General Medicine and Primary Care Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Department of Health Care Quality Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Aronson","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Division of General Medicine and Primary Care Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Zeidel","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis","family":"Lipsitz","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Division of Gerontology Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward R.","family":"Marcantonio","sequence":"additional","affiliation":[{"name":"Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Division of Gerontology Beth Israel Deaconess Medical Center Boston Massachusetts"},{"name":"Division of General Medicine and Primary Care Beth Israel Deaconess Medical Center Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,4,18]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"CommissionE.Population structure and ageing 2012[on\u2010line]. 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