O-3: Delirium Undetected: The impact of allied health care professional documentation on delirium detection in hospitalized elders
Dr. Sheryl Hodgson
Delirium is a common problem among older hospitalized patients. It increases mortality, morbidity, length and cost of stay. Delirium underdiagnosis exacerbates these consequences. We sought to understand the incidence of inpatient delirium and the potential role non-physician health care professionals contribute to the detection of this condition.
We conducted a retrospective chart review, in duplicate, of a random sample of 203 geriatric patients (≥70 years old) admitted to a community hospital in Ontario, Canada between April 1, 2016 and March 31, 2017. Exclusion criteria included patients admitted to critical care, stroke or non-medicine beds, or subsequent admissions during the study period. We defined delirium as a specific reference by physicians or allied health care professionals to “delirium” or a validated set of delirium “trigger words.”
Of 188 eligible charts, we found 68 cases of physician-captured delirium (36%). We identified an additional 39 charts (21%) in which allied health care workers noted delirium or a trigger word in keeping with delirium. We found delirium in 57% of this cohort of older inpatients.
Our quality improvement study found that allied health professional documentation may increase the detection of delirium. Limitations include the use of one of the trigger words in the validated protocol, “confusion” and its inability to differentiate between dementia and delirium. The risk of underdiagnosing delirium, however, is greater than the risk of over-vigilance. Our results suggest that closer collaboration between allied health care professionals and physicians may facilitate the diagnosis of delirium, contribute to timely management and potentially decrease morbidity, mortality and health care costs.
Closer multidisciplinary collaboration in hospital may improve the diagnosis of delirium in inpatients.