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. Motyl CM, Ngo L, Zhou W, Jung Y, Leslie D, Boltz M, Husser E, Inouye SK, Fick D, Marcantonio ER. (2020)

Comparative accuracy and efficiency of four delirium screening protocols. Journal of the American Geriatrics Society, 68(11), 2572–2578.

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 EK, Fick DM, Boltz M, Shrestha P, Siuta J, Malloy S, Overstreet A, Leslie DL, Ngo L, Jung Y, Inouye SK, Marcantonio ER. (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.

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. Marcantonio ER, Fick DM, Jung Y, Inouye SK, Boltz M, Leslie DL, Husser EK, Shrestha P, Moore A, Sulmonte K, Siuta J, Boustani M, Ngo LH. (2021).

Comparative implementation of a brief app‑directed delirium identification protocol by hospitalists, nurses, and nursing assistants.

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 DL, Fick DM, Moore A, Inouye SK, Jung Y, Ngo LH, Boltz M, Husser E, Shrestha P, Boustani M, Marcantonio ER.  (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.

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 EK, Fick DM, Marcantonio ER. (2023)

A pilot study testing the iOS UB‑CAM delirium app. Journal of the American Geriatrics Society, 71(6), 1999–2002.

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. Lin SY, Fick DM. (2024)

Empowering certified nursing assistants to screen for delirium: If not now, when? Journal of Gerontological Nursing.

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.