Improved detection of delirium, implementation and validation of the CAM-ICU in elderly Emergency Department patients

Meeberg, Evelien K. Van de; Festen, Suzanne; Kwant, M.; Georg, Rita R.; Izaks, Gerbrand J.; Maaten, Jan C. ter

doi:10.1097/mej.0000000000000380

Cited by 25 publications

(18 citation statements)

References 23 publications

(41 reference statements)

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“…Our experience showed that there was an increase in the number of patients diagnosed after the implementation of the instrument, as confirmed by the indicator unit. This situation was similar in other services (8)(9) . The nurse has an important role in the prevention and early identification of the dysfunction, because it establishes a close proximity to the patient that allows recognition and, thus, can contribute to improved quality of care and, consequently, its results (3) .…”

Section: Discussionmentioning

confidence: 55%

“…Health services in which the tool was implemented revealed an increase in the diagnosis of delirium,, as well as an optimized care. These factors contributed to the decision of the group to instrumentalize the nurses and implement the systematic screening of delirium (8)(9) . Studies have shown that the records made by nurses regarding delirium were important because of their impact on the outcomes of care (6,10) .…”

Section: Introductionmentioning

confidence: 99%

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Capacitação de enfermeiros na utilização de um instrumento de avaliação de delirium

Souza

Bersaneti

Siqueira

et al. 2017

Rev. Gaúcha Enferm.

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Objective:To narrate the nurses' training experience in the implementation of a systematic delirium screening tool using the Confusion Assessment Method for Intensive Care Unit. Method: Experience report covering the steps of situation diagnosis, planning, staff training and evaluation of the tool's implementation between January and March 2013 with nurses in the ICU of a tertiary hospital in São Paulo. Results: The implementation of the assessment, using the Confusion Assessment Method for Intensive Care Unit, obtained signifi cant nurse adhesion and became a service indicator. Final considerations:The experience has shown that this assessment allows the results of the work process to be analyzed and the consequent transformation of daily initiatives.

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Capacitação de enfermeiros na utilização de um instrumento de avaliação de delirium

Souza

Bersaneti

Siqueira

et al. 2017

Rev. Gaúcha Enferm.

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“…(8–11) Unfortunately, literature is scant on the incidence of ED-stay associated delirium and its potential impacts on hospital LOS, functional status, and unplanned ED returns in Canadian settings. The onset of such complication in the ED could influence hospital LOS (15) and reflect back on ED crowding.…”

Section: Discussionmentioning

confidence: 99%

“…Since this review, a few studies prospectively assessed the incidence of delirium in the ED have been published. (8–11) To our knowledge, none were conducted in a Canadian ED setting.…”

Section: Introductionmentioning

confidence: 99%

Emergency Department Stay Associated Delirium in Older Patients*

Émond

Grenier²,

Morin³

et al. 2017

Can Geri J

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BackgroundCaring for older patients can be challenging in the Emergency Department (ED). A > 12 hr ED stay could lead to incident episodes of delirium in those patients. The aim of this study was to assess the incidence and impacts of ED-stay associated delirium.MethodsA historical cohort of patients who presented to a Canadian ED in 2009 and 2011 was randomly constituted. Included patients were aged ≥ 65 years old, admitted to any hospital ward, non-delirious upon arrival and had at least a 12-hour ED stay. Delirium was detected using a modified chart-based Confusion Assessment Method (CAM) tool. Hospital length of stay (LOS) was log-transformed and linear regression assessed differences between groups. Adjustments were made for age and comorbidity profile.Results200 records were reviewed, 55.5% were female, median age was 78.9 yrs (SD:7.3). 36(18%) patients experienced ED-stay associated delirium. Nearly 50% of episodes started in the ED and within 36 hours of arrival. Comorbidity profile was similar between the positive CAM group and the negative CAM group. Mean adjusted hospital LOS were 20.5 days and 11.9 days respectively (p<.03).Conclusions1 older adult out of 5 became delirious after a 12 hr ED stay. Since delirium increases hospital LOS by more than a week, better screening and implementation of preventing measures for delirium could reduce LOS and overcrowding in the ED.

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“…The Confusion Assessment Method (CAM) is a good tool for the identification of delirium [71]. The CAM for the Intensive Care Unit (CAM-ICU) [72] has shown to have a better capacity to diagnose delirium in older patients in the ED [73]. It is recommended that cognitive status is evaluated, after ruling-out delirium, at the time of the first visit, or failing that, on ward admission.…”

Section: Evaluation Of Frailty In Older Patients With Ahfmentioning

confidence: 99%

Practical approach on frail older patients attended for acute heart failure

Martín‐Sánchez

Christ

Miró

et al. 2016

International Journal of Cardiology

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Acute heart failure (AHF) is a multi-organ dysfunction syndrome. In addition to known cardiac dysfunction, non-cardiac comorbidity, frailty and disability are independent risk factors of mortality, morbidity, cognitive and functional decline, and risk of institutionalization. Frailty, a treatable and potential reversible syndrome very common in older patients with AHF, increases the risk of disability and other adverse health outcomes. This position paper highlights the need to identify frailty in order to improve prognosis, the risk–benefits of invasive diagnostic and therapeutic procedures, and the definition of older-person-centered and integrated care plans.

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Improved detection of delirium, implementation and validation of the CAM-ICU in elderly Emergency Department patients

Abstract: The diagnosis rate of delirium after implementation of the CAM-ICU was three-fold higher than before. The CAM-ICU is a reliable screening tool in the ED, with high sensitivity, specificity, and positive and negative predictive value.

Cited by 25 publications

References 23 publications

Capacitação de enfermeiros na utilização de um instrumento de avaliação de delirium

Capacitação de enfermeiros na utilização de um instrumento de avaliação de delirium

Emergency Department Stay Associated Delirium in Older Patients*

Practical approach on frail older patients attended for acute heart failure

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