Screening for delirium within the interrai acute care assessment system

Salih, Salih A.; Paul, Sanjoy K.; Klein, Kerenaftali; Lakhan, Prabha; Gray, Leonard C.

doi:10.1007/s12603-012-0074-4

Cited by 18 publications

(16 citation statements)

References 25 publications

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“…For example, the rate of prevalent delirium in this study is lower than the rates reported in two previous Australian studies (18% and 22%) [9, 10], while the rate of incident delirium is both substantially higher and lower than rates previously reported in Australian research (2% and 25%) [9, 11]. While methodological differences are likely to underpin some of the different findings, important differences in patient characteristics across the studies are also likely to account for the different rates.…”

Section: Discussioncontrasting

confidence: 90%

Delirium in Australian Hospitals: A Prospective Study

Travers

Byrne

Pachana

et al. 2013

Current Gerontology and Geriatrics Research

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Objectives. Australian data regarding delirium in older hospitalized patients are limited. Hence, this study aimed to determine the prevalence and incidence of delirium among older patients admitted to Australian hospitals and assess associated outcomes. Method. A prospective observational study (n = 493) of patients aged ≥70 years admitted to four Australian hospitals was undertaken. Trained research nurses completed comprehensive geriatric assessments using standardized instruments including the Confusion Assessment Method to assess for delirium. Nurses also visited the wards daily to assess for incident delirium and other adverse outcomes. Diagnoses of dementia and delirium were established through case reviews by independent physicians. Results. Overall, 9.7% of patients had delirium at admission and a further 7.6% developed delirium during the hospital stay. Dementia was the most important predictor of delirium at (OR = 3.18, 95% CI: 1.65–6.14) and during the admission (OR = 4.82; 95% CI: 2.19–10.62). Delirium at and during the admission predicted increased in-hospital mortality (OR = 5.19, 95% CI: 1.27–21.24; OR = 31.07, 95% CI: 9.30–103.78). Conclusion. These Australian data confirm that delirium is a common and serious condition among older hospital patients. Hospital clinicians should maintain a high index of suspicion for delirium in older patients.

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Section: Discussioncontrasting

confidence: 90%

Delirium in Australian Hospitals: A Prospective Study

Travers

Byrne

Pachana

et al. 2013

Current Gerontology and Geriatrics Research

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“…This tool was chosen as it is imbedded in a standardised comprehensive geriatric assessment 20 and has previously shown optimal psychometric properties. 21 It screens for acute change in mental status and a change in cognition across a day. Patients were identified as having CI if they met the cut-off point for impairment on one of the applied formal tests (OMCT or the interRAI Delirium Screen) ( Table 1) or if there was a formal prior diagnosis of chronically impaired cognition (including dementia or mild cognitive impairment).…”

Section: Selection Of Participantsmentioning

confidence: 99%

Characteristics of older people with cognitive impairment attending emergency departments: A descriptive study

Schnitker

Beattie

Martin‐Khan

et al. 2016

Australasian Emergency Nursing Journal

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SummaryObjective: The objective of this paper is to describe the profile of older people with cognitive impairment (CI) presenting to emergency departments (EDs). Methods: This was a multi-centre (n = 8) observational study of a convenience sample of older (≥70 y) ED patients (n = 579). Participants were prospectively assessed for CI and surveyed for the duration of their ED stay (n = 191). A picture of patients' health status and ED responses to care needs was obtained through application of standardised assessment tools. Additionally, observations of care processes in ED were undertaken. Demographic data were collected through both ED's information system and survey. Outcome data were collected 28 days post-ED visit using follow-up telephone interviews. Results: Of 579 older persons, 191 (33%) persons met criteria for CI. The majority of older ED patients with CI in ED lived in the community (157/177, 88.7%), arrived by ambulance (116/172, 67%), were accompanied by a support person (94/149, 63%), were triaged as urgent to semiurgent (157/191, 82%), and were hospitalised (108/172, 57%). The median ED length of stay was 6 h. In ED, 53% of the sample experienced pain (92/173). Older ED patients with CI pose the following characteristics: prior hospital admissions (43/129, 33%), incontinence (61/178, 34%), * Corresponding author at: School of Nursing, Queensland University of Technology, Brisbane, Australia.

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“…The Orientation Memory Concentration Test (OMCT) 38 was used for cognitive impairment without delirium, and the interRAI delirium screen was used for delirium identification. 30 The OMCT is a paper-based screening tool that evaluates a patient's orientation, registration, and attention. Tested against a reference test (Mini-Mental State Examination [MMSE]), this tool had 95% sensitivity and 65% specificity in an older (≥65 years) ED population.…”

Section: Days])mentioning

confidence: 99%

“…Using the DSM-IV criteria for delirium, this test was found to be 90% sensitive and 69% specific for detecting delirium in an older (≥70 years) population admitted to acute medical wards. 30 The interRAI delirium screen was used in this study as it was part of a larger standardized assessment tool by interRAI, which collected data across a range of geriatric syndromes, including delirium. The interRAI delirium screen was administered during the first contact with the researcher and at least once before ED discharge.…”

Section: Days])mentioning

confidence: 99%

“…A review of the literature identified PQIs for geriatric emergency care 26 that were specifically designed for older ED patients and Assessing Care of Vulnerable Elders (ACOVE) indicators, which were intended to improve the care for vulnerable elders in the community. [27][28][29][30] These existing PQIs may be relevant for the older ED population with cognitive impairment.…”

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confidence: 99%

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Process Quality Indicators Targeting Cognitive Impairment to Support Quality of Care for Older People with Cognitive Impairment in Emergency Departments

Schnitker

Martin‐Khan

Burkett

et al. 2015

Academic Emergency Medicine

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Objectives: The objective of this study was to develop process quality indicators (PQIs) to support the improvement of care services for older people with cognitive impairment in emergency departments (ED).Methods: A structured research approach was taken for the development of PQIs for the care of older people with cognitive impairment in EDs, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and formal voting (phase 3). A systematic review of the literature identified ED processes targeting the specific care needs of older people with cognitive impairment. Existing relevant PQIs were also included. By integrating the scientific evidence and clinical expertise, new PQIs were drafted and, along with the existing PQIs, extensively discussed by an advisory panel. These indicators were field tested in eight hospitals using a cohort of older persons aged 70 years and older. After analysis of the field study data (indicator prevalence, variability across sites), in a second meeting, the advisory panel further defined the PQIs. The advisory panel formally voted for selection of those PQIs that were most appropriate for care evaluation.Results: In addition to seven previously published PQIs relevant to the care of older persons, 15 new indicators were created. These 22 PQIs were then field tested. PQIs designed specifically for the older ED population with cognitive impairment were only scored for patients with identified cognitive impairment. Following formal voting, a total of 11 PQIs were included in the set. These PQIs targeted cognitive screening, delirium screening, delirium risk assessment, evaluation of acute change in mental status, delirium etiology, proxy notification, collateral history, involvement of a nominated support person, pain assessment, postdischarge follow-up, and ED length of stay.Conclusions: This article presents a set of PQIs for the evaluation of the care for older people with cognitive impairment in EDs. The variation in indicator triggering across different ED sites suggests that there are opportunities for quality improvement in care for this vulnerable group. Applied PQIs will identify an emergency services' implementation of care strategies for cognitively impaired older ED patients. Awareness of the PQI triggers at an ED level enables implementation of targeted interventions

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Screening for delirium within the interrai acute care assessment system

Abstract: The interRAI AC delirium screening strategy is a valid measure of delirium in older subjects in acute medical wards.

Cited by 18 publications

References 25 publications

Delirium in Australian Hospitals: A Prospective Study

Delirium in Australian Hospitals: A Prospective Study

Characteristics of older people with cognitive impairment attending emergency departments: A descriptive study

Process Quality Indicators Targeting Cognitive Impairment to Support Quality of Care for Older People with Cognitive Impairment in Emergency Departments

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