Can improved intra- and inter-team communication reduce missed delirium?

Area of Science:

• Geriatric Medicine
• Neuroscience
• Psychiatry

Background:

• Delirium is a common and serious condition in hospitalized patients, particularly older adults.
• Accurate and timely diagnosis of delirium is crucial for appropriate management and improved patient outcomes.
• Previous studies have highlighted challenges in delirium recognition within acute care settings.

Purpose of the Study:

• To determine the prevalence of missed delirium diagnoses in hospitalized veterans.
• To investigate team interaction and communication in cases where delirium was not diagnosed.
• To identify factors contributing to the underdiagnosis of delirium in this population.

Main Methods:

• A retrospective analysis of 183 hospitalized veterans' records coded without a delirium diagnosis.
• Review of clinical notes using DSM-IV-TR criteria to identify cases with missed delirium.
• Comparison of delirium indicators in nursing versus clinician notes.

Main Results:

• Delirium was missed in 47 out of 52 assessed cases (90.4%).
• Highest rates of missed delirium were observed in Emergency Department (ED) and Medicine services.
• Nursing notes contained delirium indicators more frequently (70.2%) than clinician notes (41.3-43.6%).
• No delirium or cognitive screening scales were used in the workup of identified delirium cases.

Conclusions:

• Missed delirium is a significant issue in acute care veterans, necessitating improved diagnostic practices.
• Enhanced clinician-nursing communication and diligent review of patient notes are vital for reducing missed diagnoses.
• Continuing education for hospital staff by Consult Liaison (CL) services may improve delirium recognition and management.