{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T18:32:04Z","timestamp":1740162724918,"version":"3.37.3"},"reference-count":57,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T00:00:00Z","timestamp":1692662400000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009271","name":"Canadian Nurses Foundation","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100009271","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["143269","175944","950-200986"],"award-info":[{"award-number":["143269","175944","950-200986"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008794","name":"Research Manitoba","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100008794","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Older adults are at high risk of developing delirium in the emergency department (ED). Delirium associated with an ED visit is independently linked to poorer outcomes such as increased length of hospital stay and mortality. Performance measures (PMs) are needed to identify variations in the quality of delirium care to help focus improvement efforts where they are most needed. A preliminary list of 11 quality statements and 24 PMs was developed based on a synthesis of high-quality clinical practice guidelines. The purpose of this study is to gain consensus on a subset of PMs that can be used to evaluate delirium care quality for older ED patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and analysis<\/jats:title><jats:p>This protocol for a modified e-Delphi study is informed by the Guidance on Conducting and REporting DElphi Studies. Clinical experts from across Canada and internationally will be recruited through peer referral, professional organisations and social media calls for expressions of interest. A minimum of 17 participants will be recruited. The primary survey for each round will consist of closed-ended questions with the opportunity to provide comments to justify decisions and clarify understanding. Using 9-point Likert scales, participants will rate each quality statement according to the concepts of importance and actionability, then its associated PMs according to the concept of necessity. Results will be fed back to participants in subsequent rounds. A priori stopping criteria have been defined in terms of consensus and stability. A minimum of three rounds will be undertaken to allow participants to have feedback, revise previous responses, then stabilise responses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Ethics and dissemination<\/jats:title><jats:p>Ethical approval was provided at the University of Manitoba Health Research Ethics Board (ID HS25728 (H2022:340)). Informed consent will be obtained electronically using the Research Electronic Data Capture secure online platform. Knowledge translation and dissemination will be done through traditional (eg, conference presentations, peer-reviewed publications) and non-traditional (eg, ED Grand Rounds) strategies.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2023-074730","type":"journal-article","created":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T16:32:46Z","timestamp":1692721966000},"page":"e074730","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Protocol for developing a set of performance measures to monitor and evaluate delirium care quality for older adults in the emergency department using a modified e-Delphi process"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8442-1990","authenticated-orcid":false,"given":"Sarah","family":"Filiatreault","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Kreindler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy","family":"Grimshaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alecs","family":"Chochinov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malcolm","family":"Doupe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,8,22]]},"reference":[{"key":"2023082209302539000_13.8.e074730.1","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.ajem.2013.12.011","article-title":"Trends in short-stay hospitalizations for older adults from 1990 to 2010: implications for geriatric emergency care","volume":"32","author":"Greenwald","year":"2014","journal-title":"Am J Emerg Med"},{"key":"2023082209302539000_13.8.e074730.2","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.ajem.2015.05.041","article-title":"The ED as the primary source of hospital admission for older (but not younger) adults","volume":"34","author":"Greenwald","year":"2016","journal-title":"Am J Emerg Med"},{"key":"2023082209302539000_13.8.e074730.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.04.015"},{"key":"2023082209302539000_13.8.e074730.4","unstructured":"Canadian Institute for Health Information [CIHI] . Health care in Canada, 2011: A focus on seniors and aging. Ottawa, ON: CIHI, 2011. Available: https:\/\/secure.cihi.ca\/free_products\/HCIC_2011_seniors_report_en.pdf"},{"key":"2023082209302539000_13.8.e074730.5","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afn253"},{"key":"2023082209302539000_13.8.e074730.6","doi-asserted-by":"crossref","unstructured":"Hsieh SJ , Madahar P , Hope AA , et al . Clinical deterioration in older adults with delirium during early Hospitalisation: A prospective cohort study. BMJ Open 2015;5:e007496. doi:10.1136\/bmjopen-2014-007496 Available: http:\/\/bmjopen.bmj.com\/content\/5\/9\/e007496.full.pdf+html","DOI":"10.1136\/bmjopen-2014-007496"},{"key":"2023082209302539000_13.8.e074730.7","doi-asserted-by":"crossref","unstructured":"Griffith LE , Gruneir A , Fisher K , et al . Patterns of health service use in community living older adults with dementia and comorbid conditions: A population-based retrospective cohort study in Ontario, Canada. BMC Geriatr 2016;16:177. doi:10.1186\/s12877-016-0351-x Available: https:\/\/doi.org\/10.1186\/s12877-016-0351-x","DOI":"10.1186\/s12877-016-0351-x"},{"key":"2023082209302539000_13.8.e074730.8","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12692"},{"key":"2023082209302539000_13.8.e074730.9","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2011-200586"},{"key":"2023082209302539000_13.8.e074730.10","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jemermed.2019.05.024","article-title":"Unrecognized incident delirium in older emergency Department patients","volume":"57","author":"Boucher","year":"2019","journal-title":"The Journal of Emergency Medicine"},{"key":"2023082209302539000_13.8.e074730.11","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1097\/WNP.0b013e3182a73e31","article-title":"Delirium: definition, epidemiology, and diagnosis","volume":"30","author":"Neufeld","year":"2013","journal-title":"J Clin Neurophysiol"},{"key":"2023082209302539000_13.8.e074730.12","first-page":"56","article-title":"Cognitive impairment among older adults in the emergency Department","volume":"12","author":"Hirschman","year":"2011","journal-title":"West J Emerg Med"},{"key":"2023082209302539000_13.8.e074730.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.03.003"},{"key":"2023082209302539000_13.8.e074730.14","doi-asserted-by":"crossref","unstructured":"Cole MG , McCusker J , Bailey R , et al . Partial and no recovery from delirium after hospital discharge predict increased adverse events. Age Ageing January 8, 2017. doi:10.1093\/ageing\/afw153","DOI":"10.1093\/ageing\/afw153"},{"key":"2023082209302539000_13.8.e074730.15","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1111\/jgs.14276","article-title":"Postdischarge clinical outcomes in older medical patients with an emergency Department stay-associated delirium onset","volume":"64","author":"Bo","year":"2016","journal-title":"J Am Geriatr Soc"},{"key":"2023082209302539000_13.8.e074730.16","doi-asserted-by":"crossref","unstructured":"\u00c9mond M , Boucher V , Carmichael P-H , et al . Incidence of delirium in the Canadian emergency Department and its consequences on hospital length of stay: a prospective observational Multicentre cohort study. BMJ Open 2018;8:e018190. doi:10.1136\/bmjopen-2017-018190","DOI":"10.1136\/bmjopen-2017-018190"},{"key":"2023082209302539000_13.8.e074730.17","doi-asserted-by":"publisher","DOI":"10.5770\/cgj.20.246"},{"key":"2023082209302539000_13.8.e074730.18","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1017\/cem.2018.468","article-title":"Delirium in older emergency Department patients","volume":"20","author":"Eagles","year":"2018","journal-title":"CJEM"},{"key":"2023082209302539000_13.8.e074730.19","doi-asserted-by":"crossref","unstructured":"Donabedian A . An introduction to quality assurance in health care. New York, NY: Oxford University Press, 2003.","DOI":"10.1093\/oso\/9780195158090.002.0006"},{"key":"2023082209302539000_13.8.e074730.20","unstructured":"Institute of Medicine (US) Committee on Quality of Health Care in America [IOM] . Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press (US), 2001. Available: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK222274"},{"key":"2023082209302539000_13.8.e074730.21","unstructured":"Nothacker M , Stokes T , Shaw B , et al . Reporting standards for guideline-based performance measures. Implement Sci 2016;11:6. doi:10.1186\/s13012-015-0369-z Available: http:\/\/implementationscience.biomedcentral.com\/articles\/10.1186\/s13012-015-0369-z"},{"key":"2023082209302539000_13.8.e074730.22","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/13.6.469"},{"key":"2023082209302539000_13.8.e074730.23","unstructured":"Busse R , Klazinga N , Panteli D , et al ., eds. Improving healthcare quality in Europe: Characteristics, effectiveness and implementation of different strategies. United Kingdom: OECD, 2019."},{"key":"2023082209302539000_13.8.e074730.24","doi-asserted-by":"crossref","unstructured":"Parmelli E , Langendam M , Piggott T , et al . Guideline-based quality assurance: a conceptual framework for the definition of key elements. BMC Health Serv Res 2021;21. doi:10.1186\/s12913-021-06148-2 Available: https:\/\/doi.org\/10.1186\/s12913-021-06148-2","DOI":"10.1186\/s12913-021-06148-2"},{"key":"2023082209302539000_13.8.e074730.25","unstructured":"National Institute for Health and Care Excellence . Health and social care directorate quality standards process guide. Manchester: National Institute for Health and Care Excellence, 2020. Available: www.nice.org.uk"},{"key":"2023082209302539000_13.8.e074730.26","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/ajag.12451","article-title":"Quality indicators in the care of older persons in the emergency Department: A systematic review of the literature","volume":"36","author":"Burkett","year":"2017","journal-title":"Australas J Ageing"},{"key":"2023082209302539000_13.8.e074730.27","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1111\/acem.12617","article-title":"Structural quality indicators to support quality of care for older people with cognitive impairment in emergency departments","volume":"22","author":"Schnitker","year":"2015","journal-title":"Acad Emerg Med"},{"key":"2023082209302539000_13.8.e074730.28","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1111\/acem.12616","article-title":"Process quality indicators targeting cognitive impairment to support quality of care for older people with cognitive impairment in emergency departments","volume":"22","author":"Schnitker","year":"2015","journal-title":"Acad Emerg Med"},{"key":"2023082209302539000_13.8.e074730.29","doi-asserted-by":"crossref","unstructured":"Schuster S , Singler K , Lim S , et al . Quality indicators for a geriatric emergency care (Geriq-ED) \u2013 an evidence-based Delphi consensus approach to improve the care of geriatric patients in the emergency Department. Scand J Trauma Resusc Emerg Med 2020;28:68. doi:10.1186\/s13049-020-00756-3 Available: https:\/\/doi.org\/10.1186\/s13049-020-00756-3","DOI":"10.1186\/s13049-020-00756-3"},{"key":"2023082209302539000_13.8.e074730.30","doi-asserted-by":"crossref","unstructured":"Campbell SM , Kontopantelis E , Hannon K , et al . Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework. BMC Fam Pract 2011;12. doi:10.1186\/1471-2296-12-85","DOI":"10.1186\/1471-2296-12-85"},{"key":"2023082209302539000_13.8.e074730.31","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2019-209290"},{"key":"2023082209302539000_13.8.e074730.32","doi-asserted-by":"publisher","DOI":"10.2310\/8000.2011.110334"},{"key":"2023082209302539000_13.8.e074730.33","unstructured":"Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines [IOM] . Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Press, 2011. Available: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK209539"},{"key":"2023082209302539000_13.8.e074730.34","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.318.7182.527"},{"key":"2023082209302539000_13.8.e074730.35","doi-asserted-by":"publisher","DOI":"10.1136\/qhc.11.4.358"},{"key":"2023082209302539000_13.8.e074730.36","unstructured":"Langendam MW , Piggott T , Nothacker M , et al . Approaches of integrating the development of guidelines and quality indicators: a systematic review. BMC Health Serv Res 2020;20:875. doi:10.1186\/s12913-020-05665-w Available: http:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-020-05665-w"},{"key":"2023082209302539000_13.8.e074730.37","doi-asserted-by":"crossref","unstructured":"K\u00f6tter T , Blozik E , Scherer M . Methods for the guideline-based development of quality indicators--a systematic review. Implementation Sci 2012;7. doi:10.1186\/1748-5908-7-21 Available: http:\/\/implementationscience.biomedcentral.com\/articles\/10.1186\/1748-5908-7-21","DOI":"10.1186\/1748-5908-7-21"},{"key":"2023082209302539000_13.8.e074730.38","doi-asserted-by":"crossref","unstructured":"Filiatreault S , Grimshaw JM , Kreindler SA , et al . A critical appraisal and recommendation synthesis of delirium clinical practice guidelines relevant to the care of older adults in the emergency Department: an umbrella review. J Eval Clin Pract 14, 2023. doi:10.1111\/jep.13883 Available: https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/jep.13883","DOI":"10.1111\/jep.13883"},{"key":"2023082209302539000_13.8.e074730.39","doi-asserted-by":"crossref","unstructured":"Boulkedid R , Abdoul H , Loustau M , et al . Using and reporting the Delphi method for selecting Healthcare quality indicators: A systematic review. PLOS ONE 2011;6:e20476. doi:10.1371\/journal.pone.0020476 Available: https:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0020476","DOI":"10.1371\/journal.pone.0020476"},{"key":"2023082209302539000_13.8.e074730.40","unstructured":"Brown BB . Delphi Process: A Methodology Used for the Elicitation of Opinions of Experts. Santa Monica, CA: RAND Corporation, 1968. Available: https:\/\/www.rand.org\/pubs\/papers\/P3925.html"},{"key":"2023082209302539000_13.8.e074730.41","doi-asserted-by":"crossref","unstructured":"Keeney S , Hasson F , McKenna H . The delphi technique in nursing and health research. John Wiley & Sons, Ltd, 2011. doi:10.1002\/9781444392029","DOI":"10.1002\/9781444392029"},{"key":"2023082209302539000_13.8.e074730.42","doi-asserted-by":"crossref","first-page":"i","DOI":"10.3310\/hta2030","article-title":"Consensus development methods, and their use in clinical guideline development","volume":"2","author":"Murphy","year":"1998","journal-title":"Health Technol Assess"},{"key":"2023082209302539000_13.8.e074730.43","doi-asserted-by":"publisher","DOI":"10.1177\/0269216317690685"},{"key":"2023082209302539000_13.8.e074730.44","unstructured":"The EQUATOR network | enhancing the quality and transparency of health research. 2017. Available: http:\/\/www.equator-network.org\/"},{"key":"2023082209302539000_13.8.e074730.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.12.002"},{"key":"2023082209302539000_13.8.e074730.46","unstructured":"REDCap . 2021. Available: https:\/\/www.project-redcap.org\/"},{"key":"2023082209302539000_13.8.e074730.47","unstructured":"University of Manitoba - information services and technology - enterprise applications - database services - Redcap consultation. 2021. Available: https:\/\/umanitoba.ca\/computing\/ist\/service_catalogue\/enterprise_app\/database\/3210.html"},{"key":"2023082209302539000_13.8.e074730.48","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/13.6.489"},{"key":"2023082209302539000_13.8.e074730.49","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/BF03078683","article-title":"Prestatie-Indicatoren Langs de Meetlat \u2013 Het AIRE instrument","volume":"85","author":"de Koning","year":"2007","journal-title":"TVGW"},{"key":"2023082209302539000_13.8.e074730.50","first-page":"683","article-title":"QUALIFY: ein instrument Zur Bewertung von Qualit\u00e4tsindikatoren. Zeitschrift F\u00fcr \u00c4rztliche Fortbildung und Qualit\u00e4t Im Gesundheitswesen","volume":"101","author":"Reiter","year":"2008","journal-title":"German J Qual Health Care"},{"key":"2023082209302539000_13.8.e074730.51","unstructured":"National Quality Forum . NQF: measure evaluation criteria. 2021. Available: https:\/\/www.qualityforum.org\/Measuring_Performance\/Submitting_Standards\/Measure_Evaluation_Criteria.aspx"},{"key":"2023082209302539000_13.8.e074730.52","doi-asserted-by":"publisher","DOI":"10.1016\/j.techfore.2012.04.013"},{"key":"2023082209302539000_13.8.e074730.53","doi-asserted-by":"crossref","unstructured":"Holey EA , Feeley JL , Dixon J , et al . An exploration of the use of simple Statistics to measure consensus and stability in Delphi studies. BMC Med Res Methodol 2007;7:52. doi:10.1186\/1471-2288-7-52 Available: https:\/\/doi.org\/10.1186\/1471-2288-7-52","DOI":"10.1186\/1471-2288-7-52"},{"key":"2023082209302539000_13.8.e074730.54","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzv004"},{"key":"2023082209302539000_13.8.e074730.55","unstructured":"Fitch K , Bernstein SJ , Aguilar MD , et al . The RAND\/UCLA appropriateness method user\u2019s manual. Santa Monica, CA: RAND Corporation, 2001. Available: https:\/\/www.rand.org\/pubs\/monograph_reports\/MR1269.html"},{"key":"2023082209302539000_13.8.e074730.56","doi-asserted-by":"publisher","DOI":"10.1016\/0040-1625(79)90007-6"},{"key":"2023082209302539000_13.8.e074730.57","doi-asserted-by":"publisher","DOI":"10.1111\/nhs.12048"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-074730","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,19]],"date-time":"2023-12-19T14:37:06Z","timestamp":1702996626000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-074730"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8]]},"references-count":57,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8,22]]},"published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1136\/bmjopen-2023-074730"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-074730","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2023,8]]}}}