Increasing the Recognition of Delirium in Elderly Patients

Abstract

Objective To determine if an educational intervention aimed at house staff will increase knowledge about and recognition of delirium. Design Before/after study, with blinding of participants to the intent of the study. Setting University hospital in Halifax, Nova Scotia. Patients One hundred eighty‐seven control patients, seen as consecutive admissions of elderly patients (65+ years) to the General Medicine services of the Victoria General Hospital prior to the educational intervention, and 247 patients seen thereafter. Intervention Educational intervention at grand rounds, housestaff rounds, sign‐in rounds, and bedside teaching. Measurements Recognition of delirium in the admitting history or progress notes, Confusion Assessment Method (CAM) as recorded by nurses, diagnosis of delirium by independent study physicians using DSM‐IIIR criteria and the Trzepacz Delirium Symptom Rating Scale. Results Prior to the intervention, delirium or acute confusion was diagnosed in 3% of patients; after the intervention, delirium or acute confusion was diagnosed in 9% of patients (P < 0.01). Other abnormalities in mental state were noted in 8.5% of admissions prior to the intervention, and 15.6% of admissions after the intervention. After the intervention there was a significant difference in the proportion of patients in whom a mental status questionnaire had been carried out and in whom there was formal comment on various aspects of the mental state. The nursing CAM had a sensitivity of 0.68 and a specificity of 0.97. Conclusions A simple educational intervention aimed at house staff appears to be effective in changing house staff behavior. Improved recognition of delirium may lead to better patient outcomes.