Geriatric patients (≥65)
Patients with 3D syndromes (Delirium/Dementia/Depression)
Elderly with falls, frailty, incontinence, or malnutrition
Polypharmacy patients needing medication integration
Facing Taiwan's transition into a super-aged society, the emergency department (ED) is the frontline hotspot for geriatric care. Among geriatric syndromes, delirium poses a severe threat. Once it occurs, hospitalization days and costs double, mortality and complication rates rise sharply, institutionalization risk increases twofold, and dementia risk surges tenfold. However, literature shows universally low ED delirium diagnosis rates; our hospital's early statistics stood at a mere 4.3%. To break this clinical dilemma, our cross-disciplinary team established key care strategies: optimizing cross-team treatment and referral protocols, creating a unique nursing assessment mnemonic ("Pain, Bystander, Side effects, Medication, Hydration, Environment"), providing accessible education leaflets, integrating pharmacist-led medication reconciliation, and initiating immediate physician intervention. The landmark innovation lies in digitalizing the Delirium Triage Screen (DTS) and Brief Confusion Assessment Method (bCAM), embedding them directly into electronic medical and nursing order systems. This technology-integrated, interdisciplinary care significantly improved the delirium diagnosis rate, substantially reducing the 3-day ED revisit rate, 14-day readmission rate, and 1-month mortality rate. The team achieved high patient satisfaction and published results in an SCI journal, setting a new benchmark for geriatric ED quality management in Taiwan.
Integrating DTS and bCAM diagnostic tools into electronic medical and nursing order systems
Developing a delirium nursing assessment checklist with a customized mnemonic
Establishing cross-disciplinary integration among nurses, pharmacists, and physicians
Providing accessible and patient-friendly health education leaflets
Successfully improved the delirium diagnosis rate among geriatric patients
Successfully enhanced patient outcomes for geriatric delirium
Increased the delirium diagnosis rate from 4.3% to 6.9%
Reduced the 3-day ED revisit rate from 10.2% pre-intervention to 2.8%
Reduced the 14-day readmission rate from 14.1% pre-intervention to 7.3%
Lowered the 1-month mortality rate from 7.8% pre-intervention to 6.0%
Achieved high overall patient satisfaction
Standardized delirium intervention protocols
Conducted monthly interprofessional tracking and reviews
Improved geriatric delirium diagnosis rates
Enhanced clinical outcomes for geriatric delirium patients
Reduced the average length of stay (LOS)
Lowered average hospitalization costs
Achieved high overall patient satisfaction
Earned strong recognition from patients' families
Secured positive media and academic coverage
Delirium results published in SCI journal
First-in-Taiwan ER delirium IT system
Spearheaded Taiwan's geriatric emergency care policies
Integrated a cross-team, pharmacist-led medication reconciliation model
Standardized delirium screening and treatment protocols
Secured top honors from national healthcare quality awards
