Leanne M. Boehm

Background: Delirium remains under-recognized, under-measured, and inconsistently addressed in routine clinical care. The objective of this survey study was to characterize delirium-related quality indicators and clinical care implemented across healthcare settings as reported by members of the American Delirium Society.Methods: We distributed an electronic survey to active American Delirium Society members (N=279) between December 2025 and January 2026. The survey was developed by a multidisciplinary panel of delirium experts and assessed four domains of delirium care: quality indicators, risk assessment, screening, and prevention and management. Responses were retained if at least one domain was completed. Descriptive statistics were used to summarize results as counts and proportions.Results: Fifty-three members (19%) completed at least one survey section. Respondents most commonly reported practices in inpatient wards (71.7%) and intensive care or progressive care units (43.4%). Overall, 30.2% reported implementation of all four delirium care domains, and 50.9% reported having defined delirium quality indicators. Delirium screening and multicomponent prevention and management bundles were the most implemented domains, reported by 89.6% and 77.8% of respondents, respectively. Among those using validated screening tools, twice-daily screening was most common. 57.1% reported not tracking adherence to prevention and management bundles. Considerable variability existed in how delirium care was measured, documented, tracked, and operationalized.Conclusion: In this sample, delirium screening and multicomponent prevention and management bundles were commonly adopted, yet formal delirium quality indicators remained less common. Development of standardized delirium quality indicators may support benchmarking, accountability, and systematic improvement in delirium care.

My research journey began while caring for critically ill patients and questioning what happens after they leave the intensive care unit (ICU). This curiosity evolved into a systematic program of research on post–intensive care syndrome and evidence-based recovery interventions that has influenced how nurses approach the transition from critical illness survival to meaningful recovery. The goal of my research has been to eliminate delirium, oversedation, and immobilization in intensive care and to maximize the quality of survivorship for patients and family members after critical illness. I have led investigations into implementation of the ABCDEF bundle (assess, prevent, and manage pain; both spontaneous awakening and spontaneous breathing trials; choice of analgesia and sedation; delirium: assess, prevent, and manage; early mobility; family engagement and empowerment), demonstrating how organizational factors like workload burden, unit leadership, and interprofessional coordination influence implementation adherence and patient outcomes. My work in telemedicine-enhanced follow-up care of patients with post–intensive care syndrome addresses the cognitive, physical, and psychological impairments that affect more than half of ICU survivors. Work implementing ICU diary and peer support programs has shown how evidence-based interventions can support patients and family members when barriers to implementation are systematically addressed. My efforts embody interdisciplinary collaboration, integrating nursing science with implementation science, health services research, and clinical psychology. My journey illustrates how bedside observations, when coupled with rigorous inquiry, collaborative partnerships, and intentionality to let patient and family voices reshape thinking, can drive meaningful contributions that improve outcomes for patients and families beyond survival.

Survivors of critical illness commonly experience post-intensive care syndrome (PICS), including cognitive, mental health, physical, quality-of-life, and social impairments after discharge. Telemedicine may improve access to post-ICU recovery clinic care, but its feasibility and effect on recovery outcomes remain unclear. We evaluated the feasibility of a multidisciplinary telemedicine post-ICU recovery clinic and collecting 6-month outcome data. We conducted a two-site pilot feasibility randomized controlled trial at an academic medical center and regional community medical center in the southeastern United States. Adults admitted to medical or surgical ICUs with sepsis and/or acute respiratory distress syndrome were randomized 1:1 to telemedicine ICU recovery clinic visits or standard care. The intervention included two multidisciplinary visits at 3 weeks and 3 months after hospital discharge; participants accessed visits via a secure web-based personal health portal, where they videoconferenced simultaneously with an ICU clinician, pharmacist, and psychologist. Participants in the standard of care group received usual post-discharge care. Feasibility outcomes included enrollment, retention, attendance, clinician fidelity, and participant ratings of acceptability, appropriateness, and feasibility. Exploratory outcomes included cognitive, mental health (i.e., depression, anxiety, PTSD), and physical health (i.e., activities of daily living, independent activities of daily living) composite scores measured at 1 week and 6 months after hospital discharge. Of 1,108 screened patients, 91 were randomized (telemedicine, n = 46; standard care, n = 45). Among 83 participants completing the 1-week assessment, median age was 56 years, 51% were male, and 91% were White. In the telemedicine arm, 23 participants (57.5%) attended at least one visit; attendance was 55% at 3 weeks and 42.5% at 3 months among eligible participants. Primary 6-month outcome assessment was completed by 31 participants in each group (67%). Clinician participation fidelity was high, and telemedicine attendees reported favorable acceptability, appropriateness, and feasibility ratings. Exploratory analyses of PICS composite outcomes did not differ significantly between groups. A multidisciplinary telemedicine post-ICU recovery clinic and associated trial procedures were feasible, with high clinician fidelity and favorable participant ratings. Larger trials are needed to explore engagement strategies and evaluate effectiveness on long-term recovery outcomes, prioritizing inclusion of more diverse and historically underrepresented populations. NCT03926533 (posted 4/24/2019).

There is limited information on the relationship between multidisciplinary bundle compliance and long-term outcomes. We explored the association between bundle compliance and outcomes at 3 and 12 months after hospital discharge. We conducted secondary analyses of a randomized controlled trial comparing haloperidol, ziprasidone, and placebo for delirium in patients with critical illness. From 2011 to 2017, adult patients with respiratory failure and/or shock were recruited from 16 US medical centers. Participants received a daily ABCDE bundle during their critical illness. We assessed cognition, disability, mental health, quality of life, and survival over 12 months of follow-up. We analyzed data using linear mixed effects regression and Cox proportional hazards models. Among 566 participants, 418 survived to hospital discharge, 304 were assessed for 3-month outcomes, and 251 for 12-month outcomes. Median proportional bundle compliance was 97%, indicating high overall fidelity. After adjusting for covariates, greater proportional bundle compliance was associated with better functional independence and health-related quality of life, as evidenced by lower 12-month Functional Activity Questionnaire scores (β = - 9.6, CI = - 19.6, - 1.7, p = 0.04) and higher 12-month EuroQol-5D scores (β = 0.5, CI = 0.1, 0.9, p = 0.01). Greater bundle compliance was not associated with better long-term cognition, mental health, or survival. In this multi-site cohort with high-fidelity bundle compliance, greater bundle compliance was associated with less disability in instrumental activities of daily living and better health-related quality of life at 12 months, though associations were inconsistent and absent across other domains. Future research should evaluate integrated bundle care with post-discharge interventions to optimize long-term recovery. The Modifying the Impact of ICU-Associated Neurological Dysfunction-USA Study (MIND-USA), NCT01211522, https://clinicaltrials.gov/ct2/show/NCT01211522 .

Trauma-informed care (TIC) is an important and influential construct being increasingly used in clinical contexts. The principles of TIC shape the way physicians, nurses, social workers, and other healthcare providers interact with patients, leading to better outcomes, yet TIC constructs are rarely used to shape and influence the conduct of clinical research—whether in medicine generally or, more specially, with intensive care unit (ICU) patients and survivors, an often heavily traumatized group who are the focus of this review. Relying on case studies and relevant patient vignettes, this paper argues for the broad implementation of TIC principles in ICU outcomes research to uphold principles such as beneficence, to minimize potential trauma, and to better honor the unique challenges of a large, growing, and often vulnerable population. ICU experiences often involve fear, terror, loss of control, and vulnerability, which can lead to lasting psychological impacts. For ICU survivors, the process of participating in research may inadvertently re-traumatize them through various pathways, including the informed consent process, potentially distressing questions, and the environment in which patients are seen, to name a few. This paper emphasizes critical factors such as safety, trust, and privacy in shaping patients’ research participation, while outlining six key TIC principles: safety, trustworthiness and transparency, peer support, collaboration and mutuality, cultural considerations, and empowerment. By integrating these principles into clinical research practices, investigators can enhance participant welfare, reduce attrition, and improve data quality leading to better and more accurate outcomes and, most importantly, honor the humanity of participants.

Importance: Survivors of critical illness often have ongoing issues that affect functioning, including driving ability.Objective: To examine whether intensive care unit (ICU) delirium is independently associated with long-term changes in driving behaviors.Design, Setting, and Participants: This multicenter, longitudinal cohort study included 151 survivors of critical illness residing within 200 miles of Nashville, Tennessee. Survivors were surveyed 2 to 6 years after critical illness to assess the association between delirium duration and driving skills and behaviors (July 1, 2012, to April 30, 2013), and data were analyzed in 2014.Main Outcomes and Measures: The primary and secondary outcomes were self-rated driving skill (Driver Skill Inventory) and risky driving behaviors (Mini Driver Behavior Questionnaire), respectively. Exploratory outcomes included changes in driving decisions and driving-related attitudes.Results: Of 333 survivors from the original study, 151 (45.3%) were active drivers and agreed to participation at a median (range) of 3.7 (2.1-6.2) years after critical illness (median [IQR] age at enrollment, 59 [50-64] years; 87 [57.6%] male) with a median (IQR) delirium duration of 1 (0-4) day. Driving resumption occurred at a median (IQR) of 1.9 (0.8-6.0) months after ICU discharge. Delirium duration was not independently associated with self-rated driving skill or risky driving behavior measures (regression coefficients of −0.10 [95% CI, −1.13 to 0.93] for Driver Skill Inventory and–0.46 [95% CI, −1.97 to 1.06] for Mini Driver Behavior Questionnaire). Driving distances after critical illness were significantly lower than prehospitalization estimates (median [IQR], 60 [25-150] vs 105 [58-250] miles per week; P < .001). Driving skill (median [IQR], 34 [26-38] on a 48-point scale; P < .001) and safety orientation measures (median [IQR], 38 [35-46] on a 48-point scale; P < .001) were significantly lower upon return to driving. These decrements persisted among adults 65 years and older.Conclusions and Relevance: In this cohort study of survivors of critical illness, ICU delirium was not independently associated with long-term changes in driving behaviors after critical illness; survivors of critical illness self-reported significant decreases in transportation independence and driving skill after hospital discharge, independent of delirium duration during hospitalization. These results suggest that clinicians should consider transportation-related limitations relevant to short- and long-term care planning.

Background Family members of critically ill patients are known to experience short and longer term challenges, including emotional and social problems. To undertake robust future interventional research to support this cohort, we undertook a comprehensive evaluation of the measures used in family outcome research to date. Design Scoping review. We searched Medline, PsycINFO, Scopus, CINAHL, and Web of Science (core collection) for articles published between 2000 and 2024 which examined the outcomes of family members of critically ill patients. Data on outcome measures, study design, and population characteristics were extracted from eligible studies. Results We reviewed 9873 abstracts and identified 388 eligible unique family member cohorts. Across these studies, there were 59 (15.2%) randomised control trials, 287 (74.0%) observational cohorts, 8 (2.1%) quality improvement programmes, and 34 (8.8%) non-randomised controlled interventional studies. Most research was undertaken in USA, Canada, and Europe (n = 264, 67.5%). A total of 218 different outcomes measures were used across the studies included. In this review, 345 (89%) studies measured emotional or psychological outcomes, 85 (22%) measured family experience outcomes, 65 (17%) measured general functional status, quality of life or well-being outcomes, 35 (9%) measured environmental or social outcomes, and 10 (3%) measured cognitive outcomes. Conclusions We identified 388 studies which reported the outcomes of family members of critically ill patients. Over 200 different outcomes measures were utilised, exploring conceptual domains such as quality of life as well as psychological and social outcomes. The majority of studies were observational in nature with variable follow-up timelines. This review has highlighted that a core outcome measure set is essential to enable reliable, robust, and comparable interventional research in this area.