The prevalence and documentation of impaired mental status in elderly emergency department patients

Hustey, Fredric M.; Meldon, Stephen W.

doi:10.1067/mem.2002.122057

Cited by 307 publications

(259 citation statements)

References 16 publications

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“…This included, but was not limited to, the presence of confusion, impaired memory, inattentiveness, disorientation, deficits in executive functions, deficits of language, agnosia, apraxia, delusions, hallucinations or evidence of (suggested) delirium, or dementia diagnosis recognized by formal or informal cognitive screening. As there is evidence that identification and documentation of cognitive issues in older ED patients is poor, [34][35][36][37] we supplemented the data obtained from the chart audit with prospective data. Two tools were selected to identify people with cognitive impairment.…”

Section: Days])mentioning

confidence: 99%

“…In addition, the percentage of people identified as having cognitive impairment without delirium (33.8%), and with delirium (10.7%), in our study are consistent with the findings of previous ED-based studies. [34][35][36][37][49][50][51] For scoring the PQIs, the medical record was searched for data relevant to the indicator. A tool was designed to be explicit in relation to data items scored positive, but in some instances, minimal judgment by chart auditors was required.…”

Section: Limitationsmentioning

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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Section: Days])mentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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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“…9 Delirium is frequently missed and requires routine processes for quick screening and evaluation. 10 Emotions, primarily depression and anxiety disorders, can manifest as somatic symptoms such as chest pain or can be common comorbidities in patients with other illnesses. Depression is also frequently missed in ED care.…”

Section: The Domain Management Modelmentioning

confidence: 99%

The Domain Management Model-A Tool for Teaching and Management of Older Adults in Emergency Departments

Siebens

2005

Academic Emergency Medicine

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“…Frequently, an acute medical illness exacerbates confusion in patients with dementia, essentially creating coexistent acute and chronic confusional states. [2] We report a case of tramadol induced acute delirium in a patient admitted in the emergency ward which was managed by stoppage of the offending drug.…”

Section: Introductionmentioning

confidence: 99%

Acute Delirium after Injectable Tramadol

Lal¹,

Shah²,

Rajpal³

et al. 2018

AIMDR

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Introduction: Delirium and confusional states are among the most common mental disorders encountered in patients with acute medical illness, particularly among those who are older. We report a case of tramadol induced acute delirium in a patient admitted in the emergency ward which was managed by stoppage of the offending drug. Case report: A 62 year old male presented to the emergency ward with complaints of acute abdominal pain and ultrasonography revealed cholithiasis. All other investigations were unremarkable and the patients was put on conservative management including tramadol for pain relief. Few hours later, the patient developed confusion, violent behavior, and started talking irrelevantly, which subsided after he was sedated with lorazepam. Next morning, after receiving another dose of injectable tramadol, the patient again developed delirium with similar symptoms as the night before. After thorough psychiatric consultation he was diagnosed with tramadol induced delirium. As a result, tramadol was discontinued and the patient recovered completely. Conclusion: Tramadol, a commonly used analgesic in emergency and surgical settings, can lead to delirium. It is important for emergency physicians to have a high index of suspicion so that they can promptly identify the offending drug and take corrective measures.

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The prevalence and documentation of impaired mental status in elderly emergency department patients

Cited by 307 publications

References 16 publications

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

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

The Domain Management Model-A Tool for Teaching and Management of Older Adults in Emergency Departments

Acute Delirium after Injectable Tramadol

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