Quick Delirium Assessment

I made a new YouTube video to show how easy it is to assess for delirium in hospitalized medically ill patients. I’ve been thinking about setting up a randomized trial via the Randomise Me web site I posted about on 12/22/13.

So take a stab at diagnosing delirium, all you internal medicine and surgery residents, and medical students, too. I know you can do it.

Happy holidays!

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Comments

  1. Hats are a necessity around here; it’s -12 degrees right now.

    You know, our Psychosomatic Division has a new member and he’s amazed at how many consults for delirium we get. He wants to develop educational outreach to the internists and surgeons.

    I hated to tell him I’ve been there, done that, but it got me wondering what else we can do to encourage non-psychiatrists (and psychiatrists too, as you point out) to believe in their own ability to screen for and identify delirium.

    What would you suggest, George?

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    • I would think that the Internists would be relatively easy. The diagnosis is straightforward but the differential can be complex and it is in line with their usual thought processes in adult and geriatric medicine. I notice you use EPIC and you could always put it in as a decision point in terms of discharge planning – does your patient have delirium? A relevant question if nursing staff is teaching them how to inject enoxaparin for discharge.

      Surgeons would seem to have too many obstacles stacked against them. I would think that their goal would be to identify and transfer these patients to medicine. I was surprised early in my training when I had to see a number of delirious patients on a transplant service. In those days the surgeons lived in the hospital. I ended up talking with him for several hours late at night about the psychoanalytic theory of delirium. He knew a lot more about it than I did!

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      • I think it should be straightforward for internists too. It’s not.

        Surgeons are not keen on transferring their patients to medicine. They’re often not thrilled about transferring them to our Medical-Psychiatry Unit, ordinarily the best place for managing delirious patients.

        OK, I’m hooked. What in heck is the psychoanalytic theory of delirium?

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  2. Great video Jim. I actually have about 3 versions of your 3rd hat that I wear skating. When you think about it – the diagnosis is straightforward and you can also see a fair amount of it in psychiatric inpatient units and residential alcohol and drug treatment facilities. In addition to the medical causes intoxication and withdrawal are two states that people often forget to ask about. I have seen a fair number of young people admitted to inpatient psych units with a diagnosis of acute psychosis and it was really an acute intoxication or withdrawal state.

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