Objectives Because delirium is common and frequently unrecognized, this study sought to design a brief screening tool for a core feature of mental status and to validate the instrument as a serial assessment for delirium. Design Prospective cohort Setting Tertiary VA Hospital in New England Participants 100 Veterans admitted to the medical service Methods A consensus panel developed a modified version of the Richmond Agitation and Sedation Scale (RASS) to capture alterations in consciousness. Upon admission and daily thereafter, patients were screened with the modified RASS and independently, underwent a comprehensive mental status interview by a geriatric expert, who determined if the criteria for delirium were met. The sensitivity, specificity, and positive likelihood ratio (LR) of the modified RASS for delirium are reported. Results As a single assessment, the modified RASS had a sensitivity of 64% and a specificity of 93% for delirium (LR=9.4). When used to detect change, serial modified RASS assessments had a sensitivity of 74% and a specificity of 92% (LR=8.9) in both prevalent and incident delirium. When prevalent cases were excluded, any change in the modified RASS had a sensitivity of 85% and a specificity of 92% for incident delirium (LR=10.2) Conclusion When administered daily, the modified RASS has good sensitivity and specificity for incident delirium. Given the brevity of the instrument (approximately 15 seconds), consideration should be given to incorporating the modified RASS as a daily screening measure for consciousness and delirium.

Day-of-surgery cancellations are costly and frustrating for both the patient and the health care team. This is especially true in ambulatory surgical centers where it can be difficult to schedule a replacement procedure on short notice. Preoperative nurses at the University of North Carolina Health Care ambulatory surgical center were able to decrease the daily cancellation rate by 53%, increase patient satisfaction scores, and increase OR use by targeting three main reasons for cancellations during a preoperative telephone call. A nurse calls each patient three business days before the scheduled surgery and uses a script to communicate important preoperative information and to address any questions or concerns. The nurse then reports any new information or concerns he or she has learned from the telephone call to the scheduling clinic, anesthesia team, or the surgeon. These calls have resulted in major decreases in cancellations related to no shows, NPO requirements, and lack of a responsible adult present to drive the patient home.

Background Among cardiac surgery patients, those with impaired cognitive status before surgery may have longer postoperative stays than do patients with normal status and may require additional care upon discharge. Objectives To determine if preoperative scores on a screening measure for cognitive status (the Clock-in-the-Box), were associated with postoperative length of stay and discharge to a location other than home in patients who had cardiac surgery. Methods A total of 181 consecutive patients scheduled for cardiac surgery at a single site were administered the Clockin-the-Box as part of the preoperative evaluation. Scores on the Clock-in-the-Box tool, demographic and operative information, postoperative length of stay, and discharge location were collected retrospectively from medical records. Results The mean age of the patients was 68.1 years (SD, 0.7), and 99% were men. Mean postoperative length of stay was 10.5 days (SD, 8.2), and 35 patients (19%) were discharged to a facility. Scores on the Clock-in-the-Box assessment were not associated with postoperative length of stay. Increasing age, living alone before surgery, and duration of cardiopulmonary bypass were associated with discharge to a facility and were used as covariates in adjusted analyses. After adjustment, better preoperative cognitive status reduced the risk of being discharged to a facility (adjusted relative risk, 0.93; 95% confidence interval, 0.89-0.98) after cardiac surgery.