Abstract Details

Title A Quality Improvement Initiative for Emergency Department Neuropsychiatric Symptom Management in Dementia

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-001

Objective A multidisciplinary quality improvement team (“Halt-Haldol") was formed to implement DIAMOND-Lewy evidence-based guidelines with the objective of educating ED providers, reducing haloperidol use, and improving adherence to low dose use of APs for ED patients with dementia.

Background Persons with dementia are twice as likely to visit the Emergency Department (ED) compared to patients without dementia (1). Leading causes for visits include neuropsychiatric symptoms (2), frequently treated with antipsychotics (APs). APs carry high risk of worsening symptom burden throughout all stages of dementia, negatively impacting quality of life (3). We currently lack better pharmacologic alternatives, and not enough hospitals are implementing safety guidelines (4).

Design/Methods This is a single-site quality improvement study at an academic hospital. We emailed case-based survey to residents in emergency medicine, psychiatry, and neurology. The clinical case illustrated dementia with Lewy bodies and the participant had to choose appropriate pharmacologic management. Evidence-based guidelines from DIAMOND-Lewy studies (5,6) were then provided and knowledge was reassessed. Electronic medical record query (7) provided the number of patients ≥65 years old receiving APs in the ED (baseline data). We placed visual signs and modified ED order sets regarding agitation care, including removing haloperidol as a first-line therapy for geriatric patients.

Results From 2022-2023, there were 24,695 geriatric patients in the ED and 13% received APs. One-third of APs were haloperidol, increasing to 54% in patients over 85. The educational survey was sent to 91 residents and 66 (73%) responded. Pre-guideline top choices: 30% haloperidol, 27% olanzapine, and 29% quetiapine. Post-guidelines: 11% haloperidol, 9% olanzapine, and 52% quetiapine (chi-square p-value <0.003).

Conclusions While haloperidol was the most commonly used AP for older adults in our ED, education on the guidelines demonstrates an intention to switch to other APs. Future work will assess if education and order set changes will affect culture change and guideline adherence.

Authors/Disclosures
Shari M. Duarte, MD (The Ohio State University) PRESENTER	Dr. Duarte has nothing to disclose.
Abdul Gaffar Mohammed, MBBS (Ohio State University Wexner Medical Center)	Dr. Mohammed has nothing to disclose.
Lauren T. Southerland, MD	The institution of Dr. Southerland has received research support from NIH. Dr. Southerland has received personal compensation in the range of $0-$499 for serving as a speaker with The Geriatric Emergency Department Collaborative.
Sean Culver, MD	Dr. Culver has nothing to disclose.
Erin Reichert, PharmD	Mrs. Reichert has nothing to disclose.
Katherine Hunold, MD	Dr. Hunold has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for American College of Emergency Physicians.
Douglas W. Scharre, MD, FAAN (Ohio State University)	Dr. Scharre has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for BrainTest, Inc. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Otsuka. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Scharre has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eisai. Dr. Scharre has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eli Lilly. The institution of Dr. Scharre has received research support from InSightec. The institution of Dr. Scharre has received research support from Alzheimer's Therapeutic Research Institute (ATRI). The institution of Dr. Scharre has received research support from Eisai. The institution of Dr. Scharre has received research support from vTv Therapeutics. The institution of Dr. Scharre has received research support from National Institute of Health. The institution of Dr. Scharre has received research support from Eli Lilly. The institution of Dr. Scharre has received research support from Biogen. The institution of Dr. Scharre has received research support from Roche. The institution of Dr. Scharre has received research support from Percision Medicine. The institution of Dr. Scharre has received research support from Premier Research Group. The institution of Dr. Scharre has received research support from Genetch. The institution of Dr. Scharre has received research support from Avanir. The institution of Dr. Scharre has received research support from Cerevel Therapeutics. The institution of Dr. Scharre has received research support from Janssen. The institution of Dr. Scharre has received research support from Cassava. The institution of Dr. Scharre has received research support from UniQure. The institution of Dr. Scharre has received research support from Cognition Therapeutics. The institution of Dr. Scharre has received research support from Cognitive Research Corporation. The institution of Dr. Scharre has received research support from EIP. The institution of Dr. Scharre has received research support from Cognito. Dr. Scharre has received intellectual property interests from a discovery or technology relating to health care. Dr. Scharre has received intellectual property interests from a discovery or technology relating to health care.

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