Hospitalists' Lack of Knowledge of the Confusion Assessment Method: A Barrier to Systematic Validated Delirium Surveillance

Abstract

Hospital medicine providers who responded to the survey reported encountering delirium often in their clinical practice; however, they also reported poor familiarity with and demonstrated poor knowledge of the CAM. These results suggest a potential barrier to systematic inpatient delirium screening and support increased delirium education and the use of validated delirium assessments among hospitalists.

Increasing delirium skills at the front door: results from a repeated survey on delirium knowledge and attitudes

“…Furthermore, experience of working in geriatric medicine only resulted in a small improvement in knowledge [10]. Other studies of delirium in both medical inpatient and ICU settings have also shown significant deficits in doctors' understanding [11,12].…”

Documentation of delirium in the VA electronic health record

“…Nevertheless, diagnosis is often delayed [23], and problems remain with recognition and documentation of delirium by nurses [10,24-26], and by physicians [27-29]. Although there are no definitive quantitative markers available to diagnose delirium, qualitative tools such as the Confusion Assessment Method (CAM) [30] and modified Richmond Agitation and Sedation Scale (mRASS) [31] have been validated.…”

“…Early diagnosis of delirium may lead to rapid improvement with decreased length of admission and reduced long-term complications, although the relationship between diagnosis and prognostic implications remains controversial [ 2 , 18 ]. Nevertheless, diagnosis is often delayed [ 23 ], and problems remain with recognition and documentation of delirium by nurses [ 10 , 24 - 26 ], and by physicians [ 27 - 29 ]. Although there are no definitive quantitative markers available to diagnose delirium, qualitative tools such as the Confusion Assessment Method (CAM) [ 30 ] and modified Richmond Agitation and Sedation Scale (mRASS) [ 31 ] have been validated.…”

A survey study of delirium attitudes and knowledge among hospital medicine clinicians

“…Nonetheless, this work builds upon previous literature suggesting a potential discordance between clinicians' perceived knowledge of and clinical competency in delirium care and adds to the relatively limited literature focusing on hospitalist clinicians. 5,9 It is important to shape future educational interventions in the context of clinician attitudes and knowledge gaps, and follow-up focus groups may help further elucidate hospitalist perspectives contributing to the over-estimation of delirium prevalence and infrequent use of validated screening approaches. Hospital medicine clinicians may also benefit from education regarding potential long-term sequelae of delirium, including cognitive impairment and healthcare costs.…”