Impact of a system-wide multicomponent intervention on administrative diagnostic coding for delirium and other cognitive frailty syndromes: observational prospective study

Abstract

Background We determined the impact of a system-wide multicomponent intervention to improve recognition and documentation of cognitive frailty syndromes on hospital administrative coding for delirium. Methods A multicomponent intervention including introduction of structured patient assessment including cognitive/delirium screen, regular audit/feedback and educational seminars was undertaken (2012-17). Sensitivity and specificity of administrative International Classification of Diseases, 10th revision (ICD-10) delirium codes for the gold standard of prospectively clinically diagnosed delirium were calculated in consecutive patients admitted to acute medicine over five 8-week cycles (2010-18). Results Among 1,281 consecutive unselected admissions to acute medicine overall (mean / standard deviation age = 70.0/19.2 years; n=615 (48.0%) male), 320 had clinical delirium diagnosis (n=220 delirium only; n=100 delirium on dementia). Sensitivity of delirium coding increased from 12.8% (95% confidence interval (CI) 5.6-26.7) in 2010 to 60.2% (95% CI 50.1-69.7; p trend <0.0001) in 2018 while specificity remained at >99% throughout. Conclusion A multicomponent intervention increased sensitivity of hospital administrative diagnostic coding for delirium almost six-fold without increasing the false positive diagnosis rate.

Factors associated with admission to bed-based care: observational prospective cohort study in a multidisciplinary same day emergency care unit (SDEC)

“…All data were routinely acquired as part of standard patient care and anonymized data were entered into the Oxford Cognitive Co-morbidity and Frailty Ageing Research Database (ORCHARD). ORCHARD was specifically set-up to inform the care of older and frail patients and has a patient and public involvement group including older patients and carers which informs study planning and design [ 18 ]. The local research ethics committee (REC reference 18/SC/0184) has approved the use of ORCHARD data for research purposes waiving the need for informed consent, and the agreement of the OUHFT Divisional Management was also obtained for this substudy (Datix Number 3812).…”

Utility of white matter disease and atrophy on routinely acquired brain imaging for prediction of long-term delirium risk: population-based cohort study

“…Inflammation is associated with small vessel disease [ 29 ] and deterioration in white matter integrity in fronto-temporal/limbic regions may occur following delirium suggesting that systemic inflammation may be important [ 30 ]. Predisposition to delirium might explain why the relative prevalence of vascular versus other dementia in hospitalised patients is higher than in the background population [ 17 ].…”

“…OXVASC patients requiring acute hospital care for any reason are admitted either to OUHFT or to Abingdon EMU. Delirium was ascertained prospectively using the gold standard clinical diagnosis rather than from retrospective hospital administrative diagnostic (ICD-10) coded data since the latter are insensitive [ 17 ]. To identify OXVASC participants admitted to hospital over the study period, we conducted daily searches of electronic (OUHFT) and paper records (EMU) for all new admissions excluding day case procedures and cross-checked these against the register of OXVASC participants.…”

“…According to local protocols, all patients admitted to the OUHFT or EMU who are aged ≥70 or <70 years with confusion/altered behaviour or brain at-risk (e.g. stroke, Parkinson’s disease) have the OUHFT cognitive screen delivered via a standard admission proforma [ 4 , 17 ]. The OUHFT cognitive screen includes the 10-point Abbreviated Mental Test score [ 19 ] together with the Confusion Assessment Method [ 20 ] for delirium and documentation of known dementia diagnosis.…”

Cognitive Predictors of Delirium on Long-Term Follow-Up after TIA and Stroke: Population-Based Cohort Study

“…Delirium diagnosis was made according to the DSM-IV [14] criteria by STP after discussion with the OXVASC study team supplemented by review of the medical notes, including the OUHFT cognitive screen as described previously [2, 13] (see online suppl. methods; for all online suppl.…”