Author Affiliations: Healthcentric Advisors (formerly Quality Partners of Rhode Island) (Mss Baier, Voss, and Butterfield and Drs Gardner and Gravenstein), and Departments of Medicine (Drs Gardner and Gravenstein) and Health Services, Policy and Practice (Ms Baier and Dr Gravenstein), Warren Alpert Medical School of Brown University, Providence, Rhode Island.
We agree that delirium is an important and underdiagnosed condition in elderly patients who are hospitalized. Given the poor outcomes for untreated delirium and the existence of known interventions, identifying delirium prior to discharge is especially important. The Care Transitions Intervention includes educating patients and their caregivers about red flags—the signs and symptoms that should trigger outreach for follow-up care before patients' conditions require emergency department visits or hospital readmission—and delirium can be incorporated into this portion of the Care Transitions Intervention. As Alici points out, delirium must first be recognized and documented before any interventions can occur, including hospital-based measures as well as delirium-specific coaching and red flags. A delirium screen such as the Confusion Assessment Method can be performed by less-skilled individuals and could therefore be feasible for hospital staff to incorporate into their standard patient assessments for at-risk patients, such as elderly patients. We believe that the routine adoption of a delirium screening tool, such as the Confusion Assessment Method, would increase the medical recognition and management of delirium during and following patients' hospitalizations.
Baier RR, Gardner RL, Voss R, Butterfield K, Gravenstein S. Interventions to Improve Recognition of Delirium: A Sine Qua Non for Successful Transitional Care Programs—Reply. Arch Intern Med. 2012;172(1):80-81. doi:10.1001/archinternmed.2011.610