Improving Cognitive Evaluation and the Diagnosis of Delirium among Elderly Patients Visiting the Emergency Room

Abstract

Introduction: Delirium is a common problem among elderly patients seen in the emergency department (ED). Under-diagnosis of delirium by the ED team is common and can have serious implications.  In a previous study we found poor quality of cognitive assessment and no mention of delirium in the ED of a large teaching hospital in southern Israel in 2003. Aim: To evaluate cognitive assessment and delirium diagnosis two years after adding of a consultant geriatrician to the ED team.  Methods: We examined the rate of mental status assessment and the prevalence of delirium in the ED among patients older than 65 years via a retrospective chart review. Results: In a random sample utilizing medical records of 317 older people examined in the ED during 2007-2008, cognitive assessment (full or partial) was performed for 192 of 317 (60.6%) of patients (compared with only 12.5% in 2003), and 12 cases of delirium were specifically diagnosed in the ED (3.8%) compared to none in 2003. The rate of cognitive evaluation for subsequently hospitalized patients was 45% (compared with 59% in 2003). Conclusions: This study indicates a moderate improvement in the rate of cognitive evaluation and the diagnosis of delirium among elderly patients seen in an ED compared with a similar study which was published 5 years ago.