RT Journal Article
SR Electronic
T1 Impact of a system-wide multicomponent intervention on administrative diagnostic coding for delirium and other cognitive frailty syndromes: observational prospective study
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 454
OP 464
DO 10.7861/clinmed.2019-0470
VO 20
IS 5
A1 Sarah T Pendlebury
A1 Nicola G Lovett
A1 Ross J Thomson
A1 Sarah C Smith
YR 2020
UL http://www.rcpjournals.org/content/20/5/454.abstract
AB Background We determined the impact of a system-wide multicomponent intervention to improve recognition and documentation of cognitive frailty syndromes on hospital administrative coding for delirium.Methods A multicomponent intervention including introduction of structured patient assessment including cognitive/delirium screen, regular audit/feedback and educational seminars was undertaken (2012–17). Sensitivity and specificity of administrative International Classification of Diseases, 10th revision (ICD-10) delirium codes for the gold standard of prospectively clinically diagnosed delirium were calculated in consecutive patients admitted to acute medicine over five 8-week cycles (2010–18).Results Among 1,281 consecutive unselected admissions to acute medicine overall (mean / standard deviation age = 70.0/19.2 years; n=615 (48.0%) male), 320 had clinical delirium diagnosis (n=220 delirium only; n=100 delirium on dementia). Sensitivity of delirium coding increased from 12.8% (95% confidence interval (CI) 5.6–26.7) in 2010 to 60.2% (95% CI 50.1–69.7; ptrend<0.0001) in 2018 while specificity remained at >99% throughout.Conclusion A multicomponent intervention increased sensitivity of hospital administrative diagnostic coding for delirium almost six-fold without increasing the false positive diagnosis rate.