What is known |
Delirium is prevalent in patients with unplanned hospital admission and is associated with high nursing needs, increased costs, death, dependency and future dementia. Despite its importance, available data suggest that hospital administrative coding of delirium is poor. Lack of coding for delirium leads to reduced hospital reimbursement payments (tariff), suboptimal case-mix adjustment and service planning, as well as under-estimation of the cognitive frailty burden in hospital cohorts. |
What is the question |
We wished to determine the impact of a multicomponent intervention to improve the identification and documentation of cognitive frailty on the sensitivity and specificity of hospital administrative coding for delirium versus the gold standard of prospectively ascertained clinical delirium diagnosis. |
What was found |
The multicomponent intervention had a substantial impact on the accuracy of administrative coding for delirium: Sensitivity of ICD-10 coded data for the Gold standard clinical diagnosis of delirium increased six-fold from 12.8% in 2010 to 60.2% in 2018 while specificity remained at >99% throughout. The effect of the intervention was maintained trust-wide at 1 year after the study ended. |
What is the implication for practice now? |
System-wide interventions can significantly improve delirium coding without increasing false positive coding rates. Any associated costs should be offset by gains in remuneration, better case-mix adjustment and more informed service planning, commissioning and health policy. Our findings have implications for hospital coding in general: coding accuracy can be improved by relatively simple measures, even in diagnostically challenging disorders. |