Clinicians’ Perceptions of a Modified Hospital Elder Life Program for Delirium Prevention during COVID-19

OBJECTIVES: The Hospital Elder Life Program (HELP) is a multi-component delirium prevention program targeting delirium risk factors of cognitive impairment, vision and hearing impairment, malnutrition and dehydration, immobility, sleep deprivation, and medications. We created a modified and extended version of the program, HELP-ME, deployable under COVID-19 conditions, e.g., patient isolation and restricted staff and volunteer roles. We explored perceptions of interdisciplinary clinicians who implemented HELP-ME to inform its development and testing. DESIGN: Qualitative descriptive study of HELP-ME among older adults on medical and surgical services during the COVID-19 pandemic. SETTING AND PARTICIPANTS: HELP-ME staff at four pilot sites across the U.S. who implemented HELP-ME. METHODS: We held five one-hour video focus groups (5-16 participants/group) to review specific intervention protocols and the overall program. We asked participants open-endedly about positive and challenging aspects of protocol implementation. Groups were recorded and transcribed. We used directed content analysis to analyze data. RESULTS: Participants identified general, technology-related, and protocol-specific positive and challenging aspects of the program. Overarching themes included the need for enhanced customization and standardization of protocols, need for increased volunteer staffing, digital access to family members, patient technological literacy and comfort, variation in the feasibility of remote delivery among intervention protocols, and preference for a hybrid program model. Participants offered related recommendations. CONCLUSIONS AND IMPLICATIONS: Participants felt that HELP-ME was successfully implemented, with some modifications needed to address limitations of remote implementation. A hybrid model combining remote and in-person aspects was recommended as the preferred option.