Delirium Screening in the Emergency Department: Evaluation and Intervention

Abstract Background Between 8-17% of older adults, and up to 40% of those who arrive from nursing homes present with delirium upon admission to the Emergency Department [ED], yet the condition often goes undiagnosed by ED medical staff [ED staff]. We examined the rate of delirium among patients aged 65 and older who were admitted to the ED and tested the influence of raising awareness via a prospective study. Methods The study was divided into three periods: A “pre-intervention period” (T0); an “awareness period” (T1) in which information regarding delirium and its diagnosis was distributed to ED staff; a “screening period” (T2) in which dedicated evaluators screened ED patients aged 65 and older ; and a “post-intervention period” (T3), after the evaluators left the ED. Screening for delirium was performed using the Brief Confusion Assessment Method [bCAM] questionnaire. Results We found that during the T0 and T1 periods, the rate of delirium diagnosed by ED staff was lower than 1%. The rate of delirium found by the evaluators during the T2 screening period was 14.9% among the older adults who were surveyed, and 1.6%-1.9% among those not surveyed. In the T3 period, after the evaluators left the ED, the rate of delirium dropped to 0.89%. Conclusions The study provides further evidence that most cases of older adult delirium go undiagnosed by ED staff. Even after raising staff awareness, the diagnosis rate did not improve, and during the presence of dedicated delirium evaluators the rate of diagnosis increased only slightly. After they left, the rate returned to pre-intervention levels. The results highlight the need to implement mandatory delirium screening during ED triage and stay.