Background. Older adults are at high-risk of developing delirium in the emergency department (ED). However, it often goes undetected or undertreated. Performance measures (PMs) are needed to identify variations in delirium care quality and to help guide improvement strategies.

Purpose. The purpose of this research was to develop a set of guideline-based PMs to monitor and evaluate delirium care quality for older ED patients.

Methods. Research was conducted in two sequential phases, such that knowledge from Phase 1 was used to inform Phase 2. In the first phase, I conducted an umbrella review to identify and synthesize clinical practice guideline (CPG) recommendations for delirium care in older adults. The results of Phase 1 were used to develop a preliminary set of PMs, as well as their necessary precursory ‘quality statements’. In the second phase, I conducted a 3-round modified e-Delphi to reach clinical expert consensus on a final set of ED quality statements that are important and actionable for delirium care of older ED patients, and PMs that are necessary to evaluate this care.

Results. In Phase 1, 5 of 10 CPGs met criteria for inclusion in the synthesis. Included recommendations (n = 78) were grouped into four categories: screening, diagnosis, risk reduction, and management. None of the included CPGs were ED-specific but many recommendations incorporated evidence from this setting. From this synthesis, a preliminary set of 10 quality statements and 24 PMs were developed. Twenty-two experts participated in Phase 2. Panelists reached consensus at or slightly below a priori criteria on nine quality statements, nine structure PMs, and 14 process PMs.

Conclusion. This research created 23 PMs that a diverse group of experts agree should be used to monitor and evaluate delirium care quality for older adults in the ED. Developing this set of PMs advances the knowledge base by demonstrating how to develop new ED PMs instead of deriving them from previous work, as well as providing an example of rigorous methods to develop guideline-based PMs. Future research will test the feasibility of using these metrics to provide baseline data and guide delirium care improvement efforts in the ED.