{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:59:05Z","timestamp":1785401945646,"version":"3.56.0"},"reference-count":15,"publisher":"Department of Medicine, Warren Alpert Medical School at Brown University","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Delirium is associated with increased morbidity, mortality, and healthcare costs. Despite best practice guidelines recommending non-pharmacological treatment strategies, delirium is frequently sub-optimally managed with reliance on antipsychotics or benzodiazepines. To optimize delirium management at our institution, we implemented a clinical decision support tool embedded within our Epic electronic medical record (EMR). Our team developed an Our Practice Advisory (OPA) triggered by a positive delirium screening result to alert hospitalists to patients at high risk for delirium. An accompanying order set emphasized high-value management, such as frequent re-orientation, and de-emphasized antipsychotics through embedded education and \u201ccollapsing\u201d the antipsychotic section by default upon opening the order set. Mechanical restraint options were also intentionally excluded from the order set. We conducted a quasi-experimental pre-post study (December 2023 - November 2024), across two hospitals, measuring medication use, restraint use, bowel regimen orders, and provider engagement. Restraint use decreased significantly (35.4% to 23.4%, p&lt;0.001). Antipsychotic and bowel regimen use showed no improvement. Provider engagement with the order set was robust, with 76.4% of providers reviewing the order set and 40.7% placing orders. This study demonstrates that EMR-embedded clinical decision support tools can influence clinician behavior and encourage concordance with evidence-based guidelines for delirium management. Additional refinements are needed to further promote provider adherence and translate changes in provider behavior into improvements in patient outcomes.<\/jats:p>","DOI":"10.56305\/001c.159223","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T16:51:30Z","timestamp":1775062290000},"source":"Crossref","is-referenced-by-count":0,"title":["Reducing Low-Value Delirium Care Using Behavioral Design in the Electronic Medical Record"],"prefix":"10.56305","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3088-7800","authenticated-orcid":true,"given":"Robin Z","family":"Ji","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/024mw5h28","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Chicago","department":["Pritzker School of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren J","family":"Gleason","sequence":"additional","affiliation":[{"name":"UChicago Medicine","department":["Section of Geriatrics & Palliative Medicine, Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Spadoni","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/024mw5h28","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Chicago","department":["Pritzker School of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Flores","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/024mw5h28","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Chicago","department":["Methods Core, Center for Health and the Social Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3162-3780","authenticated-orcid":false,"given":"Caleb","family":"Murphy","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/000e0be47","id-type":"ROR","asserted-by":"publisher"}],"name":"Northwestern University","department":["Division of Hospital Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"35509","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"issue":"3","key":"ref1","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1093\/jamia\/ocac238","article-title":"Behavioral \"nudges\" in the electronic health record to reduce waste and misuse: 3 interventions","volume":"30","author":"C. 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Fleddermann","year":"2018","journal-title":"Am J Cardiol"},{"issue":"1","key":"ref5","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1038\/s41746-020-0221-y","article-title":"An overview of clinical decision support systems: benefits, risks, and strategies for success","volume":"3","author":"R. T. Sutton","year":"2020","journal-title":"Npj Digit Med"},{"issue":"7","key":"ref6","doi-asserted-by":"publisher","first-page":"e15653","DOI":"10.2196\/15653","article-title":"Appropriateness of Overridden Alerts in Computerized Physician Order Entry: Systematic Review","volume":"8","author":"T. N. Poly","year":"2020","journal-title":"JMIR Med Inform"},{"issue":"14","key":"ref7","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1001\/jama.291.14.1753","article-title":"Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit","volume":"291","author":"E. W. 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