INCREASING THE RECOGNITION OF DELIRIUM IN ELDERLY PATIENTS

Objective: To determine if an educational intervention aimed at house staff will increase knowledge about and recognition of delirium. Desig n: Before/after study, with blinding of participants to the intent of the study. Setting: University hospital in Halifax, Nova Scotia. Patie nts: One hundred eighty-seven control patients, seen as consecutive ad missions of elderly patients (65+ years) to the General Medicine servi ces of the Victoria General Hospital prior to the educational interven tion, and 247 patients seen thereafter. Intervention: Educational inte rvention at grand rounds, housestaff rounds, sign-in rounds, and bedsi de teaching. Measurements: Recognition of delirium in the admitting hi story or progress notes, Confusion Assessment Method (CAM) as recorded by nurses, diagnosis of delirium by independent study physicians usin g DSM-IIIR criteria and the Trzepacz Delirium Symptom Rating Scale. Re sults: Prior to the intervention, delirium or acute confusion was diag nosed in 3% of patients; after the intervention, delirium or acute con fusion was diagnosed in 9% of patients (P < 0.01). Other abnormalities in mental state were noted in 8.5% of admissions prior to the interve ntion, and 15.6% of admissions after the intervention. After the inter vention there was a significant difference in the proportion of patien ts in whom a mental status questionnaire had been carried out and in w hom there was formal comment on various aspects of the mental state. T he nursing CAM had a sensitivity of 0.68 and a specificity of 0.97. Co nclusions: A simple educational intervention aimed at house staff appe ars to be effective in changing house staff behavior. Improved recogni tion of delirium may lead to better patient outcomes.