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Delirium, DRGs, and Documentation

Larry R. Kirkland, MD
Arch Intern Med. 1995;155(21):2355. doi:10.1001/archinte.1995.00430210105017.
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In their recent article, "Detecting Delirium Among Hospitalized Older Patients," Pompei et al1 convincingly demonstrate an incidence of delirium that is usually not detected. Of 1168 patients aged 65 years or older admitted to a university teaching hospital during an 18-month period, 736 were excluded from study for a variety of reasons, leaving 432 enrolled, of whom 64 (14.8%) were given a diagnosis of delirium by the investigators. Disturbingly, none of these 64 had delirium listed by the attending physician as a discharge diagnosis, and therein lies a (or the) problem. The time and attention expended by the investigators on these patients are not apt to become standard procedure, so how can physicians be motivated to diagnose transient delirium, and to document it when diagnosed? It is fortunate that the study found that the nurse-generated Clinical Assessment of Confusion was the best of the four screening instruments tested; ie,


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