Closing the Gap Between Risk and Recognition: Improving Delirium Screening in the Pediatric Intensive Care Unit.
5 affiliations
- 1From the Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
- 2Children's Hospital Colorado, Aurora, Colo.
- 3Department of Pediatrics, Medical University of South Carolina, Charleston, S.C.
- 4Department of Medicine, University of California San Francisco School of Medicine, San Francisco, Calif.
- 5Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
Abstract
Delirium occurs in 20%-40% of pediatric intensive care unit (PICU) patients and is associated with increased morbidity, mortality, healthcare expenditure, and long-term psychological consequences. Despite the implementation of delirium screening in the Children's Hospital Colorado PICU in 2019 using the Cornell Assessment of Pediatric Delirium (CAPD) screening tool, screening compliance remained <50%. This project aimed to improve delirium screening compliance in the Children's Hospital Colorado PICU from 48% of scoring opportunities to 80% over 13 months. This quality improvement initiative was conducted in a 48-bed quaternary PICU and included 4,195 patients admitted from April 2024 to April 2025. We developed key driver diagrams and process maps using nursing surveys and workflow insights. Interventions included electronic health record embedded CAPD reminders, multidisciplinary delirium and CAPD tool education, and dissemination of a departmental delirium clinical practice resource. We extracted data from an internally developed and validated electronic health record delirium dashboard. We used statistical process control charts to evaluate outcomes. CAPD scoring compliance increased from a baseline of 48.0% to 75.9% following interventions. Positive delirium screening rates decreased from 54.6% to 44.3%. Postintervention nursing surveys showed that 100% of respondents reported a neutral or positive impact on workflow, and the proportion citing lack of reminders as a barrier decreased from 41% to less than 10%. A multidisciplinary, workflow-integrated approach substantially improved CAPD screening compliance in a high-volume, high-acuity PICU. Electronic health record-embedded reminders and targeted education are low-cost strategies for improving delirium screening adherence without increasing perceived nursing workload.
Related
- Improving Antibiotic Stewardship Through a Retrospective Study of the Diagnostic Value of Nasal Methicillin-Resistant Staphylococcus aureus Polymerase Chain Reaction for Pneumonia in Intensive Care Unit Settings
- Improving the detection, assessment, management and prevention of delirium in palliative care units (the DAMPen-Delirium II study): protocol for an implementation-to-target Type III hybrid effectiveness-implementation cluster randomised-controlled trial, economic evaluation and process evaluation of the Creating Learning Environments for Compassionate Care-Palliative (CLECC-Pal) implementation strategy.
- Virtual reality-based therapeutic intervention to prevent delirium in the intensive care unit: a systematic review of participant experiences, acceptability, and implementation implications.
- Stress hyperglycemia ratio is associated with delirium in elderly cardiac surgery patients in the postoperative intensive care unit: a multicenter retrospective cohort study.
- Incidence of Intensive Care Unit Delirium After Heart Surgery: A Feasibility Study of a Forest Environment Intervention.
BibTeX
@article{grewing2026closing,
title = {{Closing the Gap Between Risk and Recognition: Improving Delirium Screening in the Pediatric Intensive Care Unit.}},
author = {Anneliese J Grewing and Kelli Jo Welter and Sherrill Caprarola and Pablo Napky Raudales and Patrick Snyder and Heather Hammett and Irina Topoz and Sara Shankman and Shanda Cahoy and Sara Romme and Sara Galt and Armond M Esmaili and Jeffrey J Glasheen and Michele Loi and Matthew S Baker},
journal = {Pediatric quality \& safety},
year = {2026},
month = oct,
doi = {10.1097/pq9.0000000000000940},
url = {https://europepmc.org/article/MED/42953890},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Closing the Gap Between Risk and Recognition: Improving Delirium Screening in the Pediatric Intensive Care Unit.
AU - Anneliese J Grewing
AU - Kelli Jo Welter
AU - Sherrill Caprarola
AU - Pablo Napky Raudales
AU - Patrick Snyder
AU - Heather Hammett
AU - Irina Topoz
AU - Sara Shankman
AU - Shanda Cahoy
AU - Sara Romme
AU - Sara Galt
AU - Armond M Esmaili
AU - Jeffrey J Glasheen
AU - Michele Loi
AU - Matthew S Baker
PY - 2026
DA - 2026/10/28
JO - Pediatric quality & safety
DO - 10.1097/pq9.0000000000000940
UR - https://europepmc.org/article/MED/42953890
AB - Delirium occurs in 20%-40% of pediatric intensive care unit (PICU) patients and is associated with increased morbidity, mortality, healthcare expenditure, and long-term psychological consequences. Despite the implementation of delirium screening in the Children's Hospital Colorado PICU in 2019 using the Cornell Assessment of Pediatric Delirium (CAPD) screening tool, screening compliance remained <50%. This project aimed to improve delirium screening compliance in the Children's Hospital Colorado PICU from 48% of scoring opportunities to 80% over 13 months. This quality improvement initiative was conducted in a 48-bed quaternary PICU and included 4,195 patients admitted from April 2024 to April 2025. We developed key driver diagrams and process maps using nursing surveys and workflow insights. Interventions included electronic health record embedded CAPD reminders, multidisciplinary delirium and CAPD tool education, and dissemination of a departmental delirium clinical practice resource. We extracted data from an internally developed and validated electronic health record delirium dashboard. We used statistical process control charts to evaluate outcomes. CAPD scoring compliance increased from a baseline of 48.0% to 75.9% following interventions. Positive delirium screening rates decreased from 54.6% to 44.3%. Postintervention nursing surveys showed that 100% of respondents reported a neutral or positive impact on workflow, and the proportion citing lack of reminders as a barrier decreased from 41% to less than 10%. A multidisciplinary, workflow-integrated approach substantially improved CAPD screening compliance in a high-volume, high-acuity PICU. Electronic health record-embedded reminders and targeted education are low-cost strategies for improving delirium screening adherence without increasing perceived nursing workload.
SN - 2472-0054
ER -