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Screening for Delirium in EDs: Seeking Validation

Screening for Delirium in EDs: Seeking Validation

About 10% of older adults who seek care in EDs throughout the United States experience delirium. The condition can foretell other health issues and causes distress to patients and caregivers. Delirium also puts patients at increased risk for poor outcomes. Studies indicate that the condition adds between $38 billion and $152 billion annually to healthcare expenditures in the U.S. Patients who are discharged home from the ED with unidentified delirium have 6-month mortality rates that are nearly three-fold higher than those of counterparts whose delirium is detected in the ED. However, studies show that emergency providers identify delirium in only 16% to 35% of cases. The Heart of the Issue Unrecognized delirium in older adults presents a major health challenge and increases the burden placed on the healthcare system. Several screening instruments have been developed to identify delirium in various settings, but the ED is a unique environment because of intense time demands and high patient volume. Caring for adults with delirium in the ED setting is challenging and requires a separately evaluated screening instrument for the condition. For a study published in Annals of Emergency Medicine, Michael A. LaMantia, MD, MPH, and colleagues conducted a systematic review of existing studies on delirium in EDs to determine why the condition is so frequently undiagnosed in older adults. “We sought to determine whether any standardized instruments had been well studied for identifying delirium in the ED,” says Dr. LaMantia. Information was collected on a range of studies performed using seven delirium screening tools in the ED environment. These included the: 1. Confusion Assessment Method (CAM). 2. CAM-ICU. 3. CAM-ED. 4....
Detecting Acute HIV in the ED

Detecting Acute HIV in the ED

Detecting HIV in the acute stage is important because patients are highly infectious at that time and may spread the infection unknowingly. “Diagnosing HIV at the acute stage can also lead to earlier treatment, which in turn can improve patient health and decrease risks for further transmission,” says Michael S. Lyons, MD, MPH. However, it can be difficult to detect HIV in the acute stage because symptoms do not stand out. In addition, the least expensive and most commonly used HIV tests often miss acute HIV. Research indicates that screening for HIV in EDs is important but controversial. This is because EDs are already overwhelmed and do not historically participate in prevention interventions. Resistance to adding HIV screening services in the ED is likely to be greatest in geographic areas of low HIV prevalence. “If acute HIV is seen more commonly than expected in EDs—even in areas of lower prevalence—then we should be motivated to do more HIV screening,” says Dr. Lyons. “We should also strive to use the best screening technology that is currently available.” Exploring the Issue For a study published in the American Journal of Public Health, Dr. Lyons and colleagues sought to better understand how many ED patients have undiagnosed HIV in the acute stages of infection. A cross-sectional seroprevalence study was conducted, enrolling 926 randomly selected adults (ages 18 to 64) from an urban ED in an area of low-to-moderate HIV prevalence. According to the results, the overall prevalence of undiagnosed HIV was 0.76%, amounting to seven cases in total. While there were few cases overall, a surprisingly high percentage of these—nearly half—were in...

Adverse Events in California Hospitals: Look at the Data

According to a Bay Area television station’ s investigative exposé, California hospitals reported 6,282 adverse events to the state over the last 4 fiscal years combined. It sounds like a lot until you realize that there are 410 hospitals in California. That means the average number of adverse events per hospital is only 15.3—fewer than 4 per year. A brief summary of this story appeared on a website called California Healthline. Its lede mentioned the total number and followed it with possibly the understatement of the year “but the number of actual adverse events could be higher.” Ya think? Analyzing data by calculating averages sometimes can be misleading. For example, Stanford Hospital reported a total of 211 adverse events, and the UCSF Medical Center reported 169. That means some hospitals must have reported far fewer than the average number. The NBC article has a handy interactive tool that enables the user to click on the name of any hospital in northern California to see its total number and types of reported adverse events. Use it and note that several hospitals reported only one adverse event over the entire 4-year period. Another interesting statistic is that 3,959 or 63% of the adverse events reported were bedsores. Although bedsores can be serious problems and in most cases preventable, they pale in comparison to death or serious disability associated with the use of restraints or bed rails, operating on the wrong body part, or leaving a foreign body in a patient after surgery. Surgery performed on the wrong body part occurred 140 times. Even one is too many. One California hospital managed...
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