The Single Question in Delirium (SQiD) is a widely used delirium detection tool utilising discussion between clinicians and informants. This study aims to understand how the SQiD works in clinical settings. Using qualitative methodology, with a grounded theory framework, informant interviews were analysed to understand better how the SQiD works in clinical contexts. Participants were the adult relatives, carers, or friends (informants) of inpatients in an oncology ward at an acute hospital in Sydney, Australia. The informant was an available person whom staff would ordinarily approach for collateral information. The SQiD was administered and recorded by nursing staff. The recording was transcribed verbatim, checked, and then thematically analysed independently by two researchers. Themes/subthemes were determined and discussed until consensus was reached, then reviewed with a third researcher. Patient demographics, including documented diagnosis of delirium, were extracted from their Electronic Medical Record. Of 29 interviews, 15 patients screened positive for delirium, six of whom had a documented diagnosis of delirium. Emergent themes included recognition of “confusion”, operational factors, and the SQiD outcome. The overarching themes were clinician investment and interest in the process, communication techniques, and knowledge of delirium and other cognitive disorders. This study indicates that the SQiD’s usefulness might be enhanced by providing clinicians with specific education about delirium, and differentiation between delirium and other neurocognitive disorders. Moreover, education could be accompanied by measures to encourage clinicians to extend SQiD discussions, act on SQiD findings, and embed the SQiD in clinical practice through implementation strategies. Clinician investment was inconsistent and warrants further investigation.
{"title":"SQiD talks: A qualitative study about starting conversations with the single question in delirium (SQiD)","authors":"Nandita Hely, Megan B. Sands, Anne P.F. Wand","doi":"10.56392/001c.92217","DOIUrl":"https://doi.org/10.56392/001c.92217","url":null,"abstract":"The Single Question in Delirium (SQiD) is a widely used delirium detection tool utilising discussion between clinicians and informants. This study aims to understand how the SQiD works in clinical settings. Using qualitative methodology, with a grounded theory framework, informant interviews were analysed to understand better how the SQiD works in clinical contexts. Participants were the adult relatives, carers, or friends (informants) of inpatients in an oncology ward at an acute hospital in Sydney, Australia. The informant was an available person whom staff would ordinarily approach for collateral information. The SQiD was administered and recorded by nursing staff. The recording was transcribed verbatim, checked, and then thematically analysed independently by two researchers. Themes/subthemes were determined and discussed until consensus was reached, then reviewed with a third researcher. Patient demographics, including documented diagnosis of delirium, were extracted from their Electronic Medical Record. Of 29 interviews, 15 patients screened positive for delirium, six of whom had a documented diagnosis of delirium. Emergent themes included recognition of “confusion”, operational factors, and the SQiD outcome. The overarching themes were clinician investment and interest in the process, communication techniques, and knowledge of delirium and other cognitive disorders. This study indicates that the SQiD’s usefulness might be enhanced by providing clinicians with specific education about delirium, and differentiation between delirium and other neurocognitive disorders. Moreover, education could be accompanied by measures to encourage clinicians to extend SQiD discussions, act on SQiD findings, and embed the SQiD in clinical practice through implementation strategies. Clinician investment was inconsistent and warrants further investigation.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"2 2-4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139876134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cristian Gonzalez-Prieto, E. Groenewald, S. Yates, Bede Oulaghan, C. Rivera-Rodriguez, Daniel Wilson, Gillian Dobbie, Sarah Cullum
Both dementia and delirium are seen frequently in older hospital inpatients. Dementia is present in up to one-third of older hospital inpatients, and delirium also occurs in around one-third of older inpatients, often alongside dementia. Patients’ health outcomes, such as mortality, length of stay, and discharge to a care home, may be worse in patients with dementia and/or delirium. To describe the association of dementia and delirium with health outcomes (length of stay, mortality, care home placement) in a sample of patients from a New Zealand hospital setting. Routinely collected data from a consecutive sample of 2248 older patients assessed in a New Zealand memory service from 2013 to 2021 were extracted to examine the associations of delirium and dementia with patients’ health outcomes: length of stay, care home placement, and mortality. Of the 2248 patients assessed, 75% were hospitalised after diagnosis, and half of these had delirium screening in hospital. People with dementia had three times the risk of experiencing delirium (OR=3.0, 95% CI:2.0-4.6, p<0.001). In Pacific people compared to NZ Europeans, the adjusted relative risk ratios for having dementia only or delirium superimposed on dementia, compared to those with neither, were 2.3 (p<0.001) and 2.9 (p<0.001), respectively. Compared to people with neither diagnosis, people with delirium (with or without dementia) had a longer mean length of stay, were two to four times more likely to be placed in a care home, and the risk of death was 1.7-3.1 times higher. Delirium is very common in older hospital inpatients and has a major impact on patient outcomes and health costs. Pacific peoples seem to have greater risk of both dementia and delirium, associated with worse clinical outcomes.
{"title":"The association of dementia and delirium with health outcomes in a sample of older inpatients in a New Zealand hospital setting","authors":"Cristian Gonzalez-Prieto, E. Groenewald, S. Yates, Bede Oulaghan, C. Rivera-Rodriguez, Daniel Wilson, Gillian Dobbie, Sarah Cullum","doi":"10.56392/001c.92215","DOIUrl":"https://doi.org/10.56392/001c.92215","url":null,"abstract":"Both dementia and delirium are seen frequently in older hospital inpatients. Dementia is present in up to one-third of older hospital inpatients, and delirium also occurs in around one-third of older inpatients, often alongside dementia. Patients’ health outcomes, such as mortality, length of stay, and discharge to a care home, may be worse in patients with dementia and/or delirium. To describe the association of dementia and delirium with health outcomes (length of stay, mortality, care home placement) in a sample of patients from a New Zealand hospital setting. Routinely collected data from a consecutive sample of 2248 older patients assessed in a New Zealand memory service from 2013 to 2021 were extracted to examine the associations of delirium and dementia with patients’ health outcomes: length of stay, care home placement, and mortality. Of the 2248 patients assessed, 75% were hospitalised after diagnosis, and half of these had delirium screening in hospital. People with dementia had three times the risk of experiencing delirium (OR=3.0, 95% CI:2.0-4.6, p<0.001). In Pacific people compared to NZ Europeans, the adjusted relative risk ratios for having dementia only or delirium superimposed on dementia, compared to those with neither, were 2.3 (p<0.001) and 2.9 (p<0.001), respectively. Compared to people with neither diagnosis, people with delirium (with or without dementia) had a longer mean length of stay, were two to four times more likely to be placed in a care home, and the risk of death was 1.7-3.1 times higher. Delirium is very common in older hospital inpatients and has a major impact on patient outcomes and health costs. Pacific peoples seem to have greater risk of both dementia and delirium, associated with worse clinical outcomes.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139598658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the ever-evolving field of geriatric medicine, delirium presents enduring challenges. A promising approach to enhance care for such patients lies in the art of “Humble Inquiry”—the practice of asking genuine, curiosity-driven questions. This paper explores how this unique communication strategy, inspired by MIT Sloan School’s Edgar Schein, can be employed to revolutionize the management of delirium in older patients. Humble Inquiry opens doors to better understanding the distinctive experiences of patients and their families, fostering trust, collaboration, and allowing for tailored interventions. By providing insights into patients’ cognitive, emotional, and social needs, it promotes personalized, compassionate care. It also reduces the emotional burden on families, empowering them to be more involved in patient care. Moreover, Humble Inquiry enhances communication within healthcare teams, breaking down hierarchical barriers and promoting mutual respect and continuous learning. This is critical in delirium management, where effective teamwork ensures timely diagnosis, appropriate interventions, and seamless transitions of care. Despite its promise, the adoption of Humble Inquiry is not without challenges. Time constraints, heavy workloads, and adherence to established protocols may hinder its implementation. However, with support from healthcare organizations, professional societies, and policymakers, it can be actualized to prioritize patient-centered care. In essence, Humble Inquiry has the potential to transform delirium care by fostering a culture of curiosity, empathy, and shared understanding. The effectiveness of this approach needs rigorous evaluation, setting the stage for its broader adoption in geriatric medicine. Join us as we unveil the power of humility and inquiry in revolutionizing delirium care for older adults.
{"title":"The Power of Humble Inquiry in Delirium Care: Enhancing Communication and Collaboration for Improved Patient Outcomes","authors":"Mathias Schlögl","doi":"10.56392/001c.89969","DOIUrl":"https://doi.org/10.56392/001c.89969","url":null,"abstract":"In the ever-evolving field of geriatric medicine, delirium presents enduring challenges. A promising approach to enhance care for such patients lies in the art of “Humble Inquiry”—the practice of asking genuine, curiosity-driven questions. This paper explores how this unique communication strategy, inspired by MIT Sloan School’s Edgar Schein, can be employed to revolutionize the management of delirium in older patients. Humble Inquiry opens doors to better understanding the distinctive experiences of patients and their families, fostering trust, collaboration, and allowing for tailored interventions. By providing insights into patients’ cognitive, emotional, and social needs, it promotes personalized, compassionate care. It also reduces the emotional burden on families, empowering them to be more involved in patient care. Moreover, Humble Inquiry enhances communication within healthcare teams, breaking down hierarchical barriers and promoting mutual respect and continuous learning. This is critical in delirium management, where effective teamwork ensures timely diagnosis, appropriate interventions, and seamless transitions of care. Despite its promise, the adoption of Humble Inquiry is not without challenges. Time constraints, heavy workloads, and adherence to established protocols may hinder its implementation. However, with support from healthcare organizations, professional societies, and policymakers, it can be actualized to prioritize patient-centered care. In essence, Humble Inquiry has the potential to transform delirium care by fostering a culture of curiosity, empathy, and shared understanding. The effectiveness of this approach needs rigorous evaluation, setting the stage for its broader adoption in geriatric medicine. Join us as we unveil the power of humility and inquiry in revolutionizing delirium care for older adults.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"97 40","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139612292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Montgomery, Peter Smerdely, Louise Hickman, Alicia Wu, Victoria Traynor
To evaluate an interactive delirium educational intervention on confidence and competence in delirium assessment tools and delirium knowledge; delirium knowledge scores; clinical practice; planned practice change and perceived usefulness of the education. We conducted a quasi-experimental pilot study, with qualitative follow-up, at two metropolitan hospital sites in Australia. Participants were active registered healthcare practitioners. Survey data were collected pre (T0) and six weeks after the educational intervention (T1). Scores were derived from the seven-item OSCE marking rubric (maximum 15). At T1, observations of delirium care in practice were undertaken using a 10-item (maximum 12) tool. There was a significant increase in perceptions of confidence and competence in using delirium assessment tools and knowledge (p<0.001). Delirium knowledge scores improved significantly from 13.6 (SD 1.7) at baseline to 14.6 (SD 1.1) at T1(p<0.001). The high level of competency in delirium care demonstrated and gained during the OSCE (88.7%, SD 0.1) was translated and maintained into clinical practice (81.5%, SD 0.1) (p=0.07). Open-ended survey responses generated three themes: (1) Assess for Delirium, (2) The usefulness of The Delirium OSCE Package and, (3) A need for ongoing education on delirium care. This study generated evidence on integrating The Delirium OSCE Education Package in other clinical settings and private hospital sites. Following this pilot study, a RCT was designed using the tools and methods developed to evaluate the effectiveness of The Delirium OSCE Education Package against conventional professional development education.
{"title":"The Delirium Objective structured clinical examination Education (DOE) Pilot Study: implementation of the delirium OSCE education package within hospital education for registered healthcare professionals.","authors":"A. Montgomery, Peter Smerdely, Louise Hickman, Alicia Wu, Victoria Traynor","doi":"10.56392/001c.75386","DOIUrl":"https://doi.org/10.56392/001c.75386","url":null,"abstract":"To evaluate an interactive delirium educational intervention on confidence and competence in delirium assessment tools and delirium knowledge; delirium knowledge scores; clinical practice; planned practice change and perceived usefulness of the education. We conducted a quasi-experimental pilot study, with qualitative follow-up, at two metropolitan hospital sites in Australia. Participants were active registered healthcare practitioners. Survey data were collected pre (T0) and six weeks after the educational intervention (T1). Scores were derived from the seven-item OSCE marking rubric (maximum 15). At T1, observations of delirium care in practice were undertaken using a 10-item (maximum 12) tool. There was a significant increase in perceptions of confidence and competence in using delirium assessment tools and knowledge (p<0.001). Delirium knowledge scores improved significantly from 13.6 (SD 1.7) at baseline to 14.6 (SD 1.1) at T1(p<0.001). The high level of competency in delirium care demonstrated and gained during the OSCE (88.7%, SD 0.1) was translated and maintained into clinical practice (81.5%, SD 0.1) (p=0.07). Open-ended survey responses generated three themes: (1) Assess for Delirium, (2) The usefulness of The Delirium OSCE Package and, (3) A need for ongoing education on delirium care. This study generated evidence on integrating The Delirium OSCE Education Package in other clinical settings and private hospital sites. Following this pilot study, a RCT was designed using the tools and methods developed to evaluate the effectiveness of The Delirium OSCE Education Package against conventional professional development education.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139525080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Balasundaram, S. Y. Loh, B. H. Rosario, M. H. Tun, C. Ooi, Fuyin Li, D. Bishara
Research on prescribing processes for psychotropic medication review in older adult patients with severe behavioural symptoms of delirium and dementia appears limited. We aimed to improve and achieve 100% clinical documentation of psychotropic medication reviews against defined medication safety standards in older adult patients in geriatric wards with delirium occurrence and dementia without delirium referred to the geriatric psychiatry liaison service. The secondary aim evaluated any reduction in psychotropic medications as defined by medication safety standards by comparing pre-and post-assessments. A baseline measurement in April 2022 showed no documentation records of the study’s first three standards. PDSA methodology was employed to evaluate whether a medication review occurred following the creation and implementation of medication safety standards 1 to 4 in cycle one and adding the fifth standard in cycle 2. The first, second and third standards were medication reviews of all hypnotics, antipsychotics, and psychotropic polypharmacy. The fourth standard reviewed the anticholinergic burden scores measured by the Anticholinergic Effect on Cognition scale. The fifth standard reviewed blood pressure and postural hypotension monitoring. Using a quality improvement framework that embeds defined medication safety standards as an intervention, we have demonstrated good documentation records for a medication review to improve psychotropic prescribing processes in the older adult’s psychiatry liaison service in geriatric wards in all standards in the 2 study cycles. There was a reduction in all psychotropic medications at post-assessment as defined by the medication safety standards 1 to 4 in at least one cycle in delirium occurrence and dementia without delirium, except for zopiclone in delirium. The study’s findings in a geriatric ward setting in a public hospital in Singapore support the feasibility of embedding medication review using defined medication safety standards to improve psychotropic medication prescribing processes in older adults with delirium occurrence and dementia without delirium.
{"title":"Embedding a Quality Framework for medication safety standards in delirium and dementia: A Singapore Study in a geriatric psychiatry liaison service","authors":"B. Balasundaram, S. Y. Loh, B. H. Rosario, M. H. Tun, C. Ooi, Fuyin Li, D. Bishara","doi":"10.56392/001c.87943","DOIUrl":"https://doi.org/10.56392/001c.87943","url":null,"abstract":"Research on prescribing processes for psychotropic medication review in older adult patients with severe behavioural symptoms of delirium and dementia appears limited. We aimed to improve and achieve 100% clinical documentation of psychotropic medication reviews against defined medication safety standards in older adult patients in geriatric wards with delirium occurrence and dementia without delirium referred to the geriatric psychiatry liaison service. The secondary aim evaluated any reduction in psychotropic medications as defined by medication safety standards by comparing pre-and post-assessments. A baseline measurement in April 2022 showed no documentation records of the study’s first three standards. PDSA methodology was employed to evaluate whether a medication review occurred following the creation and implementation of medication safety standards 1 to 4 in cycle one and adding the fifth standard in cycle 2. The first, second and third standards were medication reviews of all hypnotics, antipsychotics, and psychotropic polypharmacy. The fourth standard reviewed the anticholinergic burden scores measured by the Anticholinergic Effect on Cognition scale. The fifth standard reviewed blood pressure and postural hypotension monitoring. Using a quality improvement framework that embeds defined medication safety standards as an intervention, we have demonstrated good documentation records for a medication review to improve psychotropic prescribing processes in the older adult’s psychiatry liaison service in geriatric wards in all standards in the 2 study cycles. There was a reduction in all psychotropic medications at post-assessment as defined by the medication safety standards 1 to 4 in at least one cycle in delirium occurrence and dementia without delirium, except for zopiclone in delirium. The study’s findings in a geriatric ward setting in a public hospital in Singapore support the feasibility of embedding medication review using defined medication safety standards to improve psychotropic medication prescribing processes in older adults with delirium occurrence and dementia without delirium.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"C-34 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139268253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amita Jacob, Binila Chacko, Sowmya Sathyendra, J.V. Peter, O.C. Abraham
Background Delirium is common among patients in intensive care units. Antipsychotics have been shown to reduce the incidence of delirium in post-operative patients. We set out to compare the efficacy of risperidone to placebo in preventing delirium in critically ill patients admitted to a medical ICU. Methods This double-blind, randomised controlled trial compared prophylactic low-dose risperidone to placebo in critically ill patients. Patients were screened daily for delirium using a validated screening tool (CAM-ICU), and the incidence of delirium was compared between groups. Results Forty-five patients were recruited. Baseline demographic characteristics, diagnosis and severity of illness were not statistically significantly different between groups. There was no significant difference in the incidence of delirium, adverse events or complications. Conclusion In this study, low-dose risperidone did not prevent the incidence of delirium. As delirium is a heterogeneous syndrome, a single intervention may not be effective across subtypes and aetiologies (ISRCTN17375500) Key Message Prophylactic risperidone did not reduce the incidence of delirium in ICU patients in this small study. As delirium is a heterogeneous syndrome, a single intervention may not be effective across subtypes and aetiologies.
{"title":"Low Dose Risperidone Prophylaxis for The Prevention of Delirium in The Intensive Care Unit: A Randomized, Placebo Controlled Trial","authors":"Amita Jacob, Binila Chacko, Sowmya Sathyendra, J.V. Peter, O.C. Abraham","doi":"10.56392/001c.84092","DOIUrl":"https://doi.org/10.56392/001c.84092","url":null,"abstract":"Background Delirium is common among patients in intensive care units. Antipsychotics have been shown to reduce the incidence of delirium in post-operative patients. We set out to compare the efficacy of risperidone to placebo in preventing delirium in critically ill patients admitted to a medical ICU. Methods This double-blind, randomised controlled trial compared prophylactic low-dose risperidone to placebo in critically ill patients. Patients were screened daily for delirium using a validated screening tool (CAM-ICU), and the incidence of delirium was compared between groups. Results Forty-five patients were recruited. Baseline demographic characteristics, diagnosis and severity of illness were not statistically significantly different between groups. There was no significant difference in the incidence of delirium, adverse events or complications. Conclusion In this study, low-dose risperidone did not prevent the incidence of delirium. As delirium is a heterogeneous syndrome, a single intervention may not be effective across subtypes and aetiologies (ISRCTN17375500) Key Message Prophylactic risperidone did not reduce the incidence of delirium in ICU patients in this small study. As delirium is a heterogeneous syndrome, a single intervention may not be effective across subtypes and aetiologies.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135584257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Farah Acher Kaiksow, Mustafa Quadir, Andrea Gilmore-Bykovskyi, Kaelin Rapport, Yonghe Yan, Noelle K LoConte, John Eason, Blair P Golden, Marguerite Burns
The rapidly growing population of older incarcerated patients is at increased risk of hospital-associated delirium as they have a high prevalence of comorbidities and face the unique process of accelerated aging. Our goal is to provide the first data available on identification of delirium via ICD-10 codes in this marginalized group; appropriate use of these codes communicates information across health systems and between clinicians. We examined 5,134 admissions of incarcerated patients over a 10-year period. Delirium was coded in 0.4%, significantly less than in the non-incarcerated population. Those diagnosed with delirium were six times more likely to have previously been identified as cognitively impaired via ICD-10 codes. Incarcerated patients experience incarceration-specific care processes that increase their risk of delirium, suggesting that the rate we found is a severe underestimation. This data supports future studies aimed at assessing the true rate of and risk factors for delirium in this underserved population.
{"title":"Delirium identification among older adults hospitalized while incarcerated","authors":"Farah Acher Kaiksow, Mustafa Quadir, Andrea Gilmore-Bykovskyi, Kaelin Rapport, Yonghe Yan, Noelle K LoConte, John Eason, Blair P Golden, Marguerite Burns","doi":"10.56392/001c.85001","DOIUrl":"https://doi.org/10.56392/001c.85001","url":null,"abstract":"The rapidly growing population of older incarcerated patients is at increased risk of hospital-associated delirium as they have a high prevalence of comorbidities and face the unique process of accelerated aging. Our goal is to provide the first data available on identification of delirium via ICD-10 codes in this marginalized group; appropriate use of these codes communicates information across health systems and between clinicians. We examined 5,134 admissions of incarcerated patients over a 10-year period. Delirium was coded in 0.4%, significantly less than in the non-incarcerated population. Those diagnosed with delirium were six times more likely to have previously been identified as cognitively impaired via ICD-10 codes. Incarcerated patients experience incarceration-specific care processes that increase their risk of delirium, suggesting that the rate we found is a severe underestimation. This data supports future studies aimed at assessing the true rate of and risk factors for delirium in this underserved population.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"34 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135113007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Temi Ibitoye, Thomas A Jackson, Daniel Davis, Alasdair M J MacLullich
Background: Little information is available on change in delirium coding rates over time in major healthcare systems. We examined trends in delirium discharge coding rates in older patients in hospital admissions to the National Health Service (NHS) in England and Scotland between 2012 and 2020.
Methods: Hospital administrative coding data were sourced from NHS Digital England and Public Health Scotland. We examined rates of delirium (F05 from ICD-10) in patients aged ≥70 years in 5 year and ≥90 age bands.
Results: There were approximately 7,000,000 discharges/year in England and 700,000/year in Scotland. Substantially increased delirium coding was observed for all age bands between 2012/2013 and 2019/2020 (p<0.001, Mann Kendall's tau). In the ≥90 age band, there was a 4-fold increase between 2012 and 2020.
Conclusion: Delirium coding rates have shown large increases in the NHS in England and Scotland, likely reflecting several factors including policy initiatives, detection tool implementation and education.
背景：关于主要医疗系统中谵妄编码率随时间变化的信息很少。我们研究了 2012 年至 2020 年间英格兰和苏格兰国民健康服务系统（NHS）住院的老年患者谵妄出院编码率的变化趋势。方法：医院行政编码数据来自英格兰国民健康服务系统（NHS Digital England）和苏格兰公共卫生系统（Public Health Scotland）。我们以 5 岁和≥90 岁为年龄段，研究了年龄≥70 岁患者的谵妄（ICD-10 中的 F05）发病率：结果：英格兰每年约有 7,000,000 例出院病例，苏格兰每年约有 700,000 例出院病例。2012/2013年至2019/2020年期间，所有年龄段的谵妄编码率均大幅上升（p结论：谵妄编码率在英格兰和苏格兰的国家医疗服务体系中出现大幅增长，这可能反映了包括政策措施、检测工具实施和教育在内的多种因素。
{"title":"Trends in delirium coding rates in older hospital inpatients in England and Scotland: full population data comprising 7.7M patients per year show substantial increases between 2012 and 2020.","authors":"Temi Ibitoye, Thomas A Jackson, Daniel Davis, Alasdair M J MacLullich","doi":"10.56392/001c.84051","DOIUrl":"10.56392/001c.84051","url":null,"abstract":"<p><strong>Background: </strong>Little information is available on change in delirium coding rates over time in major healthcare systems. We examined trends in delirium discharge coding rates in older patients in hospital admissions to the National Health Service (NHS) in England and Scotland between 2012 and 2020.</p><p><strong>Methods: </strong>Hospital administrative coding data were sourced from NHS Digital England and Public Health Scotland. We examined rates of delirium (F05 from ICD-10) in patients aged ≥70 years in 5 year and ≥90 age bands.</p><p><strong>Results: </strong>There were approximately 7,000,000 discharges/year in England and 700,000/year in Scotland. Substantially increased delirium coding was observed for all age bands between 2012/2013 and 2019/2020 (p<0.001, Mann Kendall's tau). In the ≥90 age band, there was a 4-fold increase between 2012 and 2020.</p><p><strong>Conclusion: </strong>Delirium coding rates have shown large increases in the NHS in England and Scotland, likely reflecting several factors including policy initiatives, detection tool implementation and education.</p>","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"2023 ","pages":"84051"},"PeriodicalIF":0.0,"publicationDate":"2023-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7614999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10163244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kwak, Matthew Jones, Courtney Mills, Kimberly York, Jacqueline Auletti, Nuzha Amjad, Prakash Balan, Mark T Warner
Optimal delirium care requires a multicomponent approach. However, implementation of such comprehensive care in a fast-paced specialized unit like acute cardiac care unit is challenging. The Age-Friendly Health System (AFHS) 4Ms initiative focuses on four key components, What Matters, Medication, Mentation, and Mobility, and provides a simple but comprehensive framework for optimal delirium care. However, studies reporting the application of AFHS 4Ms focusing on delirium care are lacking. We aimed to evaluate the feasibility of the AFHS 4Ms on delirium detection and management among older adults in acute cardiac care units. We conducted a quality improvement (QI) project using the AFHS 4Ms framework and implemented specific strategies for each M in the acute cardiac care units at a tertiary teaching hospital. Then, we assessed the changes in the rates of delirium screening and the rates of positive screening results during the QI project period using Cochran-Armitage test, and compared the percentages of older adults who received delirium-related orders before and after the initiative using Fisher’s exact test. The overall rate of delirium screening was 79.5% (68.3% in August, 81.0% in September, 87.2% in October, 87.9% in November, and 72.9% in December). The overall rate of positive delirium screening results was 9.3% (6.3% in August, 10.8% in September, 8.5% in October, 6.0% in November, and 5.0% in December). The utilization of all of the delirium-related orders was reduced, 2.4% to 1.9% for haloperidol, 6.9% to 5.1% for lorazepam, 6.5% to 3.0% for a physical restraint order, and 4.1% to 2.6% for a sitter order, before and after the initiative. However, all of the decreasing trends were not statistically significant. We showed that it is feasible to apply AFHS 4Ms for delirium detection and management in acute cardiac care units. Future prospective studies are needed.
{"title":"Feasibility of the Age-Friendly Health System in Acute Cardiac Care Units for Delirium Detection and Management","authors":"M. Kwak, Matthew Jones, Courtney Mills, Kimberly York, Jacqueline Auletti, Nuzha Amjad, Prakash Balan, Mark T Warner","doi":"10.56392/001c.84053","DOIUrl":"https://doi.org/10.56392/001c.84053","url":null,"abstract":"Optimal delirium care requires a multicomponent approach. However, implementation of such comprehensive care in a fast-paced specialized unit like acute cardiac care unit is challenging. The Age-Friendly Health System (AFHS) 4Ms initiative focuses on four key components, What Matters, Medication, Mentation, and Mobility, and provides a simple but comprehensive framework for optimal delirium care. However, studies reporting the application of AFHS 4Ms focusing on delirium care are lacking. We aimed to evaluate the feasibility of the AFHS 4Ms on delirium detection and management among older adults in acute cardiac care units. We conducted a quality improvement (QI) project using the AFHS 4Ms framework and implemented specific strategies for each M in the acute cardiac care units at a tertiary teaching hospital. Then, we assessed the changes in the rates of delirium screening and the rates of positive screening results during the QI project period using Cochran-Armitage test, and compared the percentages of older adults who received delirium-related orders before and after the initiative using Fisher’s exact test. The overall rate of delirium screening was 79.5% (68.3% in August, 81.0% in September, 87.2% in October, 87.9% in November, and 72.9% in December). The overall rate of positive delirium screening results was 9.3% (6.3% in August, 10.8% in September, 8.5% in October, 6.0% in November, and 5.0% in December). The utilization of all of the delirium-related orders was reduced, 2.4% to 1.9% for haloperidol, 6.9% to 5.1% for lorazepam, 6.5% to 3.0% for a physical restraint order, and 4.1% to 2.6% for a sitter order, before and after the initiative. However, all of the decreasing trends were not statistically significant. We showed that it is feasible to apply AFHS 4Ms for delirium detection and management in acute cardiac care units. Future prospective studies are needed.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75495598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Eeles, O. Tronstad, D. Flaws, A. Teodorczuk, Peter Worthy, N. Dissanayaka
Delirium is frequently missed in clinical practice. We used a user-centred redesign process to evaluate and adapt an existing electronic delirium screening tool (eDIS-ICU) for use in the medical setting. In phase 1, we conducted a brainstorming session to establish context for delirium screening tools in medicine. In phase 2, a pluralistic walkthrough of eDIS-ICU was performed to identify prospective usability in the medical setting. We then extracted positive and negative qualities of eDIS-ICU. In phase 3, recommendations for change were made. Pluralistic walkthrough highlighted that eDIS-ICU related to the key groups of functionality, diagnosis, links with management and potential integration with clinical information. Recommended changes to make eDIS-ICU suitable for use in a medical setting included the need for skip function, prior instructions and streamlined testing. A human-centred redesign created a pilot electronic delirium screening tool for use in a general medical setting (eDIS-MED).
{"title":"Adaptation of an electronic delirium screening tool for use in the medical setting based on a human centered design approach","authors":"E. Eeles, O. Tronstad, D. Flaws, A. Teodorczuk, Peter Worthy, N. Dissanayaka","doi":"10.56392/001c.77497","DOIUrl":"https://doi.org/10.56392/001c.77497","url":null,"abstract":"Delirium is frequently missed in clinical practice. We used a user-centred redesign process to evaluate and adapt an existing electronic delirium screening tool (eDIS-ICU) for use in the medical setting. In phase 1, we conducted a brainstorming session to establish context for delirium screening tools in medicine. In phase 2, a pluralistic walkthrough of eDIS-ICU was performed to identify prospective usability in the medical setting. We then extracted positive and negative qualities of eDIS-ICU. In phase 3, recommendations for change were made. Pluralistic walkthrough highlighted that eDIS-ICU related to the key groups of functionality, diagnosis, links with management and potential integration with clinical information. Recommended changes to make eDIS-ICU suitable for use in a medical setting included the need for skip function, prior instructions and streamlined testing. A human-centred redesign created a pilot electronic delirium screening tool for use in a general medical setting (eDIS-MED).","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"59 Pt B 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79951697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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