Naoko Onizuka , Fernando A. Huyke-Hernández , Myriam A. Roby , Tom F. Martell , Rachael M. Scislow , Sarah C. Jones , Andrew Olson , Nicole James , Julie A. Switzer
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Including missed diagnoses, delirium prevalence was higher in the sample compared to all patients (35.7% vs 15.3%, p < 0.001). Most missed diagnoses were due to failure in identifying delirium (60%) or failure in documenting/coding diagnosis (20%). The prevalence of baseline cognitive impairment was higher in undiagnosed delirium patients versus correctly diagnosed patients (80% vs 20%, p = 0.001).</p></div><div><h3>Conclusions</h3><p>Our institution significantly underreports delirium among hip fracture patients mainly due to; (1) failure to identify delirium by the clinical staff, and (2) failure to document/code diagnosis despite correct identification. Baseline cognitive impairment can render delirium diagnosis challenging. 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引用次数: 2
摘要
在发现我院髋部骨折患者谵妄发生率较低后,我们评估了这是否是由于漏报所致,如果是,则发生了处理错误。方法选择年龄≥60岁伴有谵妄的骨折患者。基于图表的谵妄鉴别仪(CHART-DEL)识别谵妄的漏诊。流程图是根据员工访谈和观察创建的。结果谵妄发生率为15.3%(176例)。在随机抽样(n = 98)中,15名患者(15.5%)被诊断,而20名患者(24.7%)尽管有谵妄的证据但未被诊断。包括漏诊在内,样本中谵妄患病率高于所有患者(35.7% vs 15.3%, p <0.001)。大多数漏诊是由于未能识别谵妄(60%)或未能记录/编码诊断(20%)。未确诊谵妄患者的基线认知障碍患病率高于正确诊断的患者(80% vs 20%, p = 0.001)。结论我院对髋部骨折患者谵妄的低报主要是由于;(1)临床工作人员未能识别谵妄,(2)尽管有正确的识别,但未能记录/编码诊断。基线认知障碍可使谵妄诊断具有挑战性。这些可作为质量改善和髋部骨折护理加强的目标。
A quality improvement project addressing the underreporting of delirium in hip fracture patients
Introduction
After discovering a low incidence of delirium for hip fracture patients at our institution, we evaluated if this was due to underreporting and, if so, where process errors occurred.
Methods
Hip fracture patients aged ≥60 with a diagnosis of delirium were identified. Chart-Based Delirium Identification Instrument (CHART-DEL) identified missed diagnoses of delirium. Process maps were created based off staff interviews and observations.
Results
The incidence of delirium was 15.3% (N = 176). Within a random sample (n = 98), 15 patients (15.5%) were diagnosed, while 20 (24.7%) went undiagnosed despite evidence of delirium. Including missed diagnoses, delirium prevalence was higher in the sample compared to all patients (35.7% vs 15.3%, p < 0.001). Most missed diagnoses were due to failure in identifying delirium (60%) or failure in documenting/coding diagnosis (20%). The prevalence of baseline cognitive impairment was higher in undiagnosed delirium patients versus correctly diagnosed patients (80% vs 20%, p = 0.001).
Conclusions
Our institution significantly underreports delirium among hip fracture patients mainly due to; (1) failure to identify delirium by the clinical staff, and (2) failure to document/code diagnosis despite correct identification. Baseline cognitive impairment can render delirium diagnosis challenging. These serve as targets for quality improvement and hip fracture care enhancement.