Introduction: Older patients who arrive to the emergency room with delirium have a worse prognosis than others. Early detection and treatment of this problem has been shown to improve outcome. We have launched a project at our hospital to improve the care of patients who arrive delirious to the medical emergency room. The present article describes lessons that can be learned from this pilot initiative. Methods: All patients older than 70 years admitted to the department of internal medicine were screened for delirium in the emergency room using the 4AT screening tool. Data of patients with a 4AT score ≥5 (or with incomplete score) were transferred to the geriatric unit of the hospital. On the ward, the presence of delirium was confirmed by a geriatric nurse that validated that the patient could walk with support and ordered mobilization and physiotherapy (Mamp;P). Results: Over the 2 and a half years (10 quarters) allocated for the pilot project, 1,078 medical patients with delirium were included in this survey. In 59.3%, the diagnosis of delirium could be confirmed only after admission. Due to budgetary constraints, only 54.7% received the allocated specific intervention – early Mamp;P. Since it was decided that randomization was not appropriate for our initiative, we found that patients who received Mamp;P had lower (better) 4AT scores on admission, and lower mortality. No significant difference was found between the patients who received Mamp;P and the others in length of hospitalization and discharge to nursing homes. Retrospective comparison of the two groups did not enable to determine whether Mamp;P was given to the patients for whom it was most effective. Conclusions: It is often not possible to verify in the emergency room that the cognitive decline is indeed new, that is, is due to delirium, and measures must be taken to verify this point as soon as possible after admission. Due to numerous constraints, the availability of early Mamp;P is often insufficient. Whenever resources are scarce and randomization is avoided, adequate criteria should be found for allocating existing dedicated staff to patients for whom early mobilization is likely to be most beneficial.
Dement Geriatr Cogn Disord Extra 2021;11:134–139

中文翻译：

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内科谵妄患者的早期发现和干预：试点计划的经验教训

简介：因谵妄进入急诊室的老年患者预后比其他人差。该问题的早期发现和治疗已被证明可以改善结果。我们在医院启动了一个项目，以改善对到达医疗急诊室的精神错乱患者的护理。本文介绍了可以从该试点计划中吸取的经验教训。方法：内科收治的所有 70 岁以上患者均在急诊室使用 4AT 筛查工具进行谵妄筛查。将 4AT 评分≥5（或评分不完整）的患者数据转移到医院的老年病房。在病房里，一位老年护士证实了谵妄的存在，证实患者可以在支持下行走，并要求进行活动和物理治疗 (Mamp;P)。结果：在为试点项目分配的 2 年半（10 个季度）中，有 1,078 名谵妄内科患者被纳入本次调查。59.3%的患者只有入院后才能确诊谵妄。由于预算限制，只有 54.7% 接受了分配的具体干预措施——早期 Mamp;P。由于决定随机化不适合我们的倡议，我们发现接受 Mamp;P 的患者入院时 4AT 评分较低（较好），死亡率较低。接受 Mamp;P 的患者与其他患者在住院时间和出院时间方面没有显着差异。两组的回顾性比较无法确定 Mamp;P 是否给予最有效的患者。结论：在急诊室往往无法验证认知能力下降确实是新的，即是由于谵妄，必须在入院后尽快采取措施验证这一点。由于诸多限制，早期 Mamp;P 的可用性往往不足。当资源稀缺且避免随机化时，应找到适当的标准，将现有的专职人员分配给早期活动可能最有益的患者。
Dement Geriatr Cogn Disord Extra 2021；11：134–139