Delirium screening and alerting systems for older hospital inpatients

Delirium often goes unrecognized in the hospital, leading to missed opportunities for management. The objective of this study was to test a multicomponent program for delirium screening and reporting for older, hospitalized adults.

We implemented a multicomponent delirium screening and alerting program within two university hospital units for all patients ≥ 70 years of age. The initiative compared performance of the 4 'A's Test, Nursing Delirium Screening Scale, and Confusion Assessment Method. Additionally, the study team provided recurrent educational sessions with nurses and implemented pager and electronic health record alerts for patients who screened positive for delirium. Nurses were then surveyed about their perspectives, and clinical outcomes were abstracted from the medical record.

Compared to the Confusion Assessment Method, the proportion of positive screens was significantly higher (positive screens/admissions) with the 4 'A's Test (49/448, 11% vs. 12/399, 3%, p < 0.001) and the Nursing Delirium Screening Scale (83/539, 15% vs. 12/399, 3%, p < 0.001). Among surveyed nurses, 32/41 (78%) expressed that the alerting system provided at least "moderate" motivation to screen for delirium, and 35/41 (85%) voiced that it provided at least "moderate" motivation to record positive screens. Most respondents (23/42, 55%) reported recurrent educational sessions as "very helpful." Positive screens were associated with higher mortality (6.6% vs. 1.9%, p = 0.003), longer hospitalizations (13 [± 11] days vs. 7 [± 11], p < 0.001), and higher likelihood of discharge to care facilities (45% vs. 23%, p < 0.001).

Positive delirium screening rates were higher with the 4AT and NuDesc compared to the CAM. Additionally, alerting systems and educational initiatives served as motivating factors for delirium screening and charting.