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Related Concept Videos

Methods of Documentation IV: Focus Charting01:26

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Focus Charting, also known as the focus charting system or "focus documentation," is a systematic documentation approach used in healthcare to organize patient information in medical records.
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Related Experiment Video

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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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A tale of two methods: chart and interview methods for identifying delirium.

Jane S Saczynski1, Cyrus M Kosar, Guoquan Xu

  • 1Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.

Journal of the American Geriatrics Society
|February 12, 2014
PubMed
Summary

Comparing delirium identification methods, a combined approach using interviews and chart reviews captured the most cases. This comprehensive strategy offers better detection of delirium in older surgical patients.

Keywords:
deliriumepidemiologymethodology

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Area of Science:

  • Geriatric Medicine
  • Critical Care Medicine
  • Surgical Patient Care

Background:

  • Delirium is a common complication in older adults undergoing surgery.
  • Accurate identification of delirium is crucial for timely intervention and improved patient outcomes.
  • Existing methods for delirium detection, such as chart review and direct patient interviews, have limitations.

Purpose of the Study:

  • To compare the effectiveness of interview-based (Confusion Assessment Method - CAM) and chart-based methods for identifying delirium in elderly surgical patients.
  • To evaluate the agreement and characteristics of delirium cases identified by each method.
  • To assess the predictive validity of each method for clinical outcomes.

Main Methods:

  • A prospective cohort study involving 300 individuals aged 70 and older undergoing major elective surgery.
  • Daily interviews using the CAM and medical chart reviews were conducted to identify delirium.
  • Agreement rates, case characteristics, and predictive validity for length of stay, complications, and discharge disposition were analyzed.

Main Results:

  • The combined approach identified the highest cumulative incidence of delirium (27%), compared to interview-based (23%) and chart-based (12%) methods alone.
  • Overall agreement between methods was 80% (kappa = 0.30), with differences in detecting specific delirium features and onset times.
  • The combined method demonstrated high predictive validity for clinical outcomes.

Conclusions:

  • Both interview- and chart-based methods have unique strengths in delirium identification.
  • A combined approach is superior for capturing a broader range and larger number of delirium cases in this population.
  • Integrating both methods enhances the comprehensive detection of delirium.