Managing Delirium Among Elderly Patients in the ED

Managing Delirium Among Elderly Patients in the ED

National estimates demonstrate that elderly patients are increasingly presenting for care at EDs throughout the United States each year, and by current projections, this trend is expected to increase significantly as Americans are living longer than ever. Between 10% and 30% of the elderly who are evaluated in the ED will present with delirium, but the prevalence may be higher. “The causes of delirium in elderly patients presenting to EDs are multifactorial,” explains Medley O’Keefe Gatewood, MD (Table 1). “While it’s difficult to discern exactly what’s going on clinically, delirium is oftentimes the only sign of underlying serious and potentially life-threatening illnesses. Much like myocardial infarction and sepsis, delirium is a high-stakes entity.” Research has suggested that emergency physicians are inconsistent in recognizing mental status impairment and the signs and symptoms indicative of a delirium diagnosis in the elderly. Recent analyses have shown that emergency physicians correctly diagnose delirium in only about 24% to 35% of elderly patients, and many of these individuals are discharged with little consideration of delirium as an indicator of more serious medical conditions. Diagnosing Delirium Among the Elderly “Failing to detect delirium among the elderly in the ED and then discharging them can increase mortality within the first few months of discharge and up to a year,” says Dr. Gatewood, who coauthored an article in the May 2012 Western Journal of Emergency Medicine on the topic. “Even when delirium is diagnosed, some patients are still inappropriately discharged. Considering the high prevalence of impaired mental status and the increasing number of elderly patients who have delirium and are still discharged, emergency physicians must make greater...

Electronic Health Records Present Potential Malpractice Threat

One of the highly touted benefits of electronic health records (EHRs) is reducing malpractice incidents and medical errors by providing improved documentation, an automatic safeguard against medication errors and drug interactions, and a system to track test results and follow up with patients. However, physicians who aren’t careful when implementing and using an EHR can increase their malpractice liability. According to a November article published in the New England Journal of Medicine, physicians should be aware of malpractice pitfalls of EHR use. Some of these include the following: The initial transition from paper to electronic records may create documentation gaps. Failure of clinicians to use EHRs consistently may lead to gaps in documentation and communication. E-mail advice multiplies the number of clinical encounters that could give rise to claims and may heighten the risk of claims if advice is offered without thorough investigation and examination of the patient. More extensive documentation of clinical decisions and activity creates more discoverable evidence for plaintiffs, including metadata. Temptation to copy and paste patient histories instead of taking new histories risks missing new information and perpetuates previous mistakes. Failure to reply to patient e-mails in a timely fashion could constitute negligence and raise patient ire. Better access to clinical information through EHRs could create legal duties to act on the information. While the benefits of EHRs far exceed the drawbacks, awareness of potential consequences is critical to ensure patient safety as well as the integrity of a...