Delirium

Inouye, Sharon K.

doi:10.1007/0-387-22621-4_77

Cited by 2 publications

(2 citation statements)

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“…Suboptimal mental status documentation during patient transfer could adversely affect patient health by causing missed diagnosis of delirium and unmet patient care needs. Importantly, delirium is present in 14% to 22% of older adults upon admission to the hospital, 12,25 but studies have shown that nurse and physician providers do not recognize delirium in one third to two thirds of cases 26–28 . Delirium is particularly difficult to recognize in patients with dementia, 28 who make up the majority of the study sample.…”

Section: Discussionmentioning

confidence: 99%

“…Monitoring the mental status of older patients transferred between providers or facilities is important because change in mental status can be a sign of acute disease, 1–5 and mental status abnormalities necessitate specific approaches to clinical and custodial care. In addition, recognition of delirium at the time of care transfer is important because of its association with adverse outcomes, 6–11 its implications for urgent evaluation and treatment, and its potential for prevention 12–14 . Essential to mental status evaluation and recognition of delirium are knowledge of the patient's usual mental status and its most recent stability over time.…”

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confidence: 99%

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Ineffective communication of mental status information during care transfer of older adults

2005

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BACKGROUND: Monitoring and documenting the mental status of older patients transferred between providers or facilities is important because mental status change can be a sign of acute disease and mental status abnormalities necessitate specific approaches to care. OBJECTIVES: To identify patient and illness factors associated with presence of a mental status description in inter‐facility transfer documents and to describe the content and concurrent validity of transfer mental status descriptions when they occur. DESIGN: Retrospective study. PARTICIPANTS: Individuals transferred between 5 long‐term and 2 acute care facilities in an urban setting. MEASUREMENTS: Trained research personnel reviewed hospital and nursing home medical records and inter‐facility transfer documents. Mental status descriptions in transfer documents were coded as abnormal or normal within 5 domains: alertness, communication, orientation/memory, behavior, and mood. Descriptions were compared with mental status items in the nursing home Minimum Data Set and in a transfer communication checklist. RESULTS: In all, 123 nursing home residents experienced 174 hospital admissions. Mental status descriptions were present in 69% of transfer documents. A total of 67% of patients missing a transfer mental status description upon nursing home‐to‐hospital transfer had dementia. Factors associated with presence of a transfer mental status description were urgent transfer, nursing home of origin, and among patients without dementia, greater cognitive impairment. When present, a mean of 1.47 (SD=0.81) cognitive domains were documented in transfer mental status descriptions. Agreement between transfer mental status descriptions and comparison sources was fair to good (κ=.31 to .73). CONCLUSION: Mental status documentation during transfer of older adults between nursing home and hospital did not identify all patients with dementia and did not completely characterize patients' cognitive status.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%