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Documenting Pediatric Delirium During Transitions of Care: A Single Site Observational Study
Matthew S Hazle1, Gabrielle Horner1,2, Melissa Ross1,2
1Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
Insights
Pediatric providers frequently fail to document delirium in children transferred from the pediatric intensive care unit (PICU) to the pediatric hospital medicine (PHM) service, despite positive screening. This underdocumentation risks worse patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Child Neurology
- Healthcare Quality Improvement
Background:
- Delirium is a frequent complication in critically ill children, associated with adverse outcomes.
- Effective management of pediatric delirium requires accurate documentation during care transitions.
- The Cornell Assessment of Pediatric Delirium (CAPD) is a validated screening tool for pediatric delirium.
Purpose of the Study:
- To determine the rates of delirium documentation during care transitions.
- To identify factors associated with delirium documentation in pediatric patients.
- To assess documentation at transfer from the pediatric intensive care unit (PICU) to the pediatric hospital medicine (PHM) service and at hospital discharge.
Main Methods:
- Retrospective analysis of 337 patient encounters (ages 0-21) from 2016-2022.
- Inclusion criteria: screened positive for delirium via CAPD before PICU to PHM transfer.
- Outcomes: documentation of "delirium" at PICU transfer and hospital discharge; statistical analysis using bivariate and multivariate logistic regression.
Main Results:
- Delirium was documented in only 20% of transfers and 18% of discharges.
- Factors increasing documentation included psychiatry consultation and invasive mechanical ventilation (MV).
- Black race was associated with decreased odds of documentation; Black race (OR 0.275), psychiatry consultation (OR 66.82), and invasive MV (OR 6.495) at transfer.
Conclusions:
- Despite using a validated screening tool, pediatric delirium documentation is notably low during care transitions.
- Inadequate documentation may compromise patient safety and lead to poorer outcomes.
- Psychiatry consultation and invasive MV are key factors associated with increased delirium documentation.
Abstract:
BackgroundDelirium is a common complication of illness. Patients who experience delirium are at risk for worse outcomes during and after hospitalization. This study aims to describe rates of, and factors associated with, delirium documentation during care transitions for patients who screened positive for delirium in the pediatric intensive care unit (PICU) at transfer to the pediatric hospital medicine (PHM) service and discharge.MethodsDemographic and clinical characteristics were collected retrospectively on patients ages 0-21 years, without developmental delay, who screened positive via Cornell Assessment of Pediatric Delirium (CAPD) before transferring from PICU to PHM service of a tertiary-care children's hospital from 2016-2022. Primary outcomes were documentation of "delirium" at PICU transfer and hospital discharge. Statistical analysis included bivariate analysis and multivariate logistic regression.ResultsOf 337 encounters, 66 transfer (20%) and 62 discharge notes (18%) documented delirium. On bivariate analysis, older age, female sex, Hispanic ethnicity, prolonged and elevated CAPD scoring, longer PICU and hospital length of stay, mechanical ventilation (MV), and psychiatry consultation were associated with documentation at transfer. On logistic regression, Black race decreased odds (OR 0.275, 95% CI 0.08-0.84) while psychiatry consultation (OR 66.82, 24.45-212.25) and invasive MV (OR 6.495, 2.13-22.34) increased odds of documentation. Discharge documentation demonstrated similar associations, except sex and ethnicity were not associated, while neurology consultation was positively associated with documentation. On logistic regression, psychiatry consultation (OR 36.01, 14.51-100.71) and invasive MV (OR 2.96, 1.09-8.83) increased odds of documentation at discharge.ConclusionsDespite a validated screening tool, pediatric providers often fail to document delirium at PICU transfer and hospital discharge. Lack of documentation may leave patients and families at risk for worse outcomes.
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