Summary of Findings

  • Efficiency & Accuracy: UB‑CAM is rapid (~1–2 min) with high sensitivity (~93%) and specificity (~95%) compared to full CAM protocols.

  • Feasibility: Routinely implemented by diverse clinical staff across settings with very high completion, accuracy >85–90%.

  • Cost-effectiveness: CNA-performed screenings cost fractionally less per screen than nurses or physicians.

  • Implementation: Adoption depends on workflow fit, role clarity, physical environment, and clinician buy-in.

  • Empowerment: CNA-led first-step screens enhance early delirium detection and staff engagement.

Research Evidence for the use of the UB-CAM

1. Leslie, D. L., Motyl, C. M., Ngo, L., Zhou, W., Jung, Y., & Inouye, S. K. (2020)

Comparative accuracy and efficiency of four delirium screening protocols. Journal of the American Geriatrics Society, 68(11), 2572–2578.
Full text: Available open-access via PubMed Central intpsychogeriatrics.org+13pmc.ncbi.nlm.nih.gov+13agsjournals.onlinelibrary.wiley.com+13.
Summary: In a simulation study (n = 531), the UB‑CAM protocol (UB‑2 + 3‑D CAM with skip) achieved ~93% sensitivity and 95% specificity, with screening completed in 1 min 14 sec—nearly 2 min faster than full 3D‑CAM. Highly time-efficient without performance loss.

2. Husser, E. K., Fick, D. M., Boltz, M., Shrestha, P., et al. (2021)

Implementing a rapid, two-step delirium screening protocol in acute care: Barriers and facilitators. Journal of the American Geriatrics Society, 69(5), 1349–1356.
Full text: Available on Wiley via DOI .
Summary: A qualitative evaluation (n = 767 UB‑CAM trials by 322 providers across 2 hospitals) identified six contextual influences—structural, environmental, workflow, clinician role, patient factors, and innovation adaptation. Overall, clinicians welcomed the UB‑CAM as practical and brief, but highlighted implementation requires context-sensitive strategies.

3. Kuzmik, A., Ngo, L. H., Boltz, M., Shrestha, P., & Inouye, S. K. (2021).

Comparative implementation of a brief app‑directed delirium identification protocol by hospitalists, nurses, and nursing assistants.
Full text: Available open-access via PubMed Central .
Summary: This pilot within the same READI study used an iPad-based UB‑CAM app. Results: >95% completion rates, average UB‑2 in <1 min, full UB‑CAM under 2 min, and >85% accuracy compared to reference-standard assessment. Tech-enhanced workflow is feasible and reliable in clinical settings.

4. Leslie, D. L., Fick, D. M., Moore, A., Inouye, S. K., et al. (2022)

Comparative salary-related costs of a brief app‑directed delirium identification protocol by hospitalists, nurses, and nursing assistants. Journal of the American Geriatrics Society, 70(8), 2371–2378.
Full text: Accessible via PubMed Central .
Summary: In a prospective cohort (n = 527 patients; 399 clinicians), CNAs using the UB‑CAM app screened at just $0.37 per assessment, nurses at $1.10, and physicians at $3.61. Demonstrates substantial cost savings when delegating screening to lower-cost staff using app direction.

5. Kuzmik, A., Hannan, J.*, Boltz, M., Shrestha, P., Husser, E. K., Fick, D. M., & Marcantonio, E. R. (2023)

A pilot study testing the iOS UB‑CAM delirium app. Journal of the American Geriatrics Society, 71(6), 1999–2002.
Full text: Open‑access via PubMed Central hsrc.himmelfarb.gwu.edu.
Summary: In this field-based pilot (n = unknown; research testers using iPhone/iPad bedside), the iOS UB‑CAM app achieved 100% inter‑rater reliability, average completion time of approximately 90 seconds, and was rated “easy to use” with high satisfaction among non-clinician testers, including detailed instructions and visual cues embedded in the app interface.

6. Fick, D. M., & Shrestha, P. (2024)

Empowering certified nursing assistants to screen for delirium: If not now, when? Journal of Gerontological Nursing.
Full text: Available via Healio/Harlan publications .
Summary: Highlights CNA-led screening: 399 clinicians across >500 patients utilized UB‑CAM with ~90% accuracy. The article advocates broad CNA adoption due to their patient familiarity and cost-effectiveness, especially when using the two-step protocol with the UB‑Cam app.