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Open Access Publications from the University of California

Scholarly Works (3 results)

  • Article
Emergency Medicine (2021)
Delirium is an acute, fluctuating condition with an alteration in level of consciousness associated with inattention and disorganized thinking, significantly impacting mortality, morbidity and hospital length of stay. Delirium is the most common complication afflicting hospitalized patients ages 65 years and older, affecting more than 2.6 million older adults each year in the United States. 1 This study will evaluate the effects of the total time spent in the emergency department (ED), the number of times a patient is moved from one bed space to another during their ED stay, the number of hours a patient spends boarding after admission orders have been placed, on the development of delirium as an inpatient.
    Cover page: Delirium from the Emergency Department: How Does Waiting, Boarding and Multiple Bed Movements of Older Patients in the ED Contribute to the Development Of Delirium?
    • Article
    • Peer Reviewed
    Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, Volume 24, Issue 3 (2023)

    Introduction: Incident delirium in older patients is associated with prolonged hospitalization and mortality. A recent study suggested an association between emergency department (ED) length of stay (LOS), time in ED hallways, and incident delirium. In this study we further evaluated the emerging association between incident delirium with ED LOS, time in ED hallways, and number of non-clinical patient moves in the ED.

    Methods: We performed this retrospective cohort study at a single, urban, academic medical center. All data were extracted from the electronic health record. We included patients aged ≥65 years presenting to the ED and admitted to family or internal medicine services over a two-year period . Patients admitted to any other service, transferred from another hospital, discharged from the ED, or who underwent procedural sedation were excluded. The primary outcome was incident delirium, defined as a positive delirium screen, receipt of sedative medications, or use of physical restraints. Multivariable logistic regression models including age, gender, language, history of dementia, Elixhauser Comorbidity Index, number of non-clinical patient moves within the ED, total time spent in the ED hallway, and ED LOS were fitted.

    Results: We studied 5,886 patients ≥65 years of age; median age was 77 (69-83) years; 3,031 (52%) were female, and 1,361 (23%) reported a history of dementia. Overall, 1,408 (24%) patients experienced incident delirium. In multivariable models, ED LOS was associated with development of delirium (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.03, per hour), while non-clinical patient moves [OR 0.97, (95% CI 0.91-1.04) and ED hallway time [OR 0.99, 95% CI 0.98-1.01, per hour) was not associated with development of delirium.

    Conclusion: In this single-center study, ED length of stay was associated with incident delirium in older adults, while non-clinical patient moves and ED hallway time in the ED were not. Health systems should systemically limit time in the ED for admitted older adults.

      Cover page: Emergency Department Length of Stay Is Associated with Delirium in Older AdultsCreative Commons 'BY' version 4.0 license
      • Article
      Medical Education (2022)
      During the COVID-19 pandemic, medical education has drastically changed to a remote format, with independent and e-learning becoming more valuable. While virtual learning of ultrasound has shown to be effective, there is scant literature regarding the efficacy of independent remote learning of the Extended Focused Assessment with Sonography in Trauma exam (E-FAST).
        Cover page: Evaluation of Distance Learning in Basic Ultrasonography: Can E-FAST Exams be Learned through Distance Learning? 
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