{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:22:57Z","timestamp":1790295777171,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T00:00:00Z","timestamp":1759536000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG090487"],"award-info":[{"award-number":["R01AG090487"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["U19AG078105"],"award-info":[{"award-number":["U19AG078105"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,1]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n The Geriatric Emergency Department (ED) guidelines recommend screening older adults for delirium using evidence\u2010based screening tools, but these tools are often underutilized. We aimed to identify barriers and facilitators to implementing an electronic health record (EHR)\u2010based delirium screening tool as intended.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This mixed methods and focused ethnographic study combined a review of structured delirium screening data with observations of real\u2010time delirium screenings and semi\u2010structured in\u2010person interviews at an academic ED that previously implemented the Delirium Triage Screen (DTS) and Brief Confusion Assessment Method (bCAM) tool. Content analysis of field notes from observations and interview transcripts was guided by the Exploration, Preparation, Implementation, and Sustainment implementation framework.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n From a total of 40,818 ED visits, 6196 (15.2%) had incomplete screens (i.e., without fidelity). We observed 62 encounters, of which 25 (40.3%) screenings were implemented without fidelity due to (1) not asking the required screening questions, (2) assuming patient responses, or (3) not completing the screen due to uncertainty regarding a patient's baseline mentation. We conducted 32 interviews. Identified barriers included staff prioritization of other tasks (e.g., stroke code, cleaning patients), limited knowledge of the screen's importance and utility, and language discordance. Facilitators included care partners providing baseline mental status information and nurses prefacing the screening to increase patient engagement.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The fidelity of ED delirium screening is influenced by an interplay of environmental, patient, provider, and caregiver factors. Fidelity may be improved by focusing education on the importance of screening, training screeners on how to determine whether a patient's mentation is acutely changed, providing clear action steps when a patient screens positive, and addressing how to administer the delirium screen to patients who do not speak English fluently.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgs.70142","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T09:16:16Z","timestamp":1759569376000},"page":"43-54","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Barriers and Facilitators to the Fidelity of Delirium Screening in the Emergency Department: An Ethnographic Approach"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2410-6574","authenticated-orcid":false,"given":"Kayla P.","family":"Carpenter","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1632-4750","authenticated-orcid":false,"given":"Fernanda","family":"Bellolio","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA"},{"name":"Robert and Arlene Kogod Center on Aging Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7415-3955","authenticated-orcid":false,"given":"Manuela","family":"Bartolacci","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly M.","family":"Jeffery","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA"},{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan M.","family":"Bower","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Mayo Clinic Rochester Minnesota USA"},{"name":"Department of Nursing Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3561-8332","authenticated-orcid":false,"given":"Lauren T.","family":"Southerland","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine The Ohio State University Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aidan F.","family":"Mullan","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Informatics Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7658-6763","authenticated-orcid":false,"given":"Jennifer L.","family":"Ridgeway","sequence":"additional","affiliation":[{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,4]]},"reference":[{"issue":"3","key":"e_1_2_15_2_1","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/j.1553-2712.2008.00339.x","article-title":"Delirium in Older Emergency Department Patients: Recognition, Risk Factors, and Psychomotor Subtypes","volume":"16","author":"Han J. 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