An electronic medical record marker for delirium in hospitalized elderly


Center for Senior Health and Longevity, Aurora Research Institute

Presentation Notes

Presented at 2013 Aurora Scientific Day, Milwaukee, WI


Background/Significance: Delirium is an acute confusional state that is common among hospitalized elderly and is associated with poor outcomes. This syndrome requires prompt recognition and evaluation as the underlying medical condition may be life threatening. The diagnosis of delirium is made clinically and is often under-recognized.

“Acute Care for the Elders (ACE) Tracker” is an innovative automated checklist that is generated from the electronic medical record (EMR). The diagnosis of delirium is noted on ACE Tracker as being present or absent. This diagnosis is obtained from data already entered in the EMR by nurses and may be used at the patient’s bedside to improve care of hospitalized elderly.

Purpose: Can the EMR checklist provide a marker for delirium?

Methods: Data was collected on all 65 year old and older patients who were hospitalized in a large, community teaching hospital in Milwaukee, WI during the month of February, 2012. To provide a convenience sample, the ACE Tracker checklist was printed every Wednesday during the one month study period. The average day of the assessment was day 7. The collected data included demograhics, number of medications, functional status, and high risk medications (Beers). Delirium marker was defined as being present if there was: documentation of delirium by nurses, or administration of haloperidol within the prior 48 hours, or administration of physical restraint.

Results: One thousand three hundred and six patients were included in the study. The average age was 77 years. Two hundred and sixty patients had a marker of delirium detected on ACE Tracker (20%). Use of Beers medications in patients with delirium marker was fifty three percent (53%) vs. thirty three percent (33%) in patients without delirium marker; p=0.001. The rate of functional decline among those with delirium was 17.7% (46/260) compare to 8.7% (91/1046 among those without delirium; p=0.001.

Conclusion: The EMR delirium marker may be useful in the diagnosis of delirium among hospitalized elderly patients. This may help the health care team in early recognition and treatment of delirium.

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