University of Massachusetts Medical School Faculty Publications

Title

The Language of Delirium: Keywords for Identifying Delirium from Medical Records

UMMS Affiliation

Department of Medicine, Division of Geriatric Medicine; Meyers Primary Care Institute

Publication Date

8-1-2015

Document Type

Article

Subjects

Aged; Aged, 80 and over; Cohort Studies; Delirium; *Electronic Health Records; Female; Humans; Male; *Terminology as Topic

Disciplines

Geriatric Nursing | Geriatrics | Health Information Technology | Mental Disorders

Abstract

Electronic medical records (EMRs) offer the opportunity to streamline the search for patients with possible delirium. The purpose of the current study was to identify words and phrases commonly noted in charts of patients with delirium. The current study included 67 patients (nested within a cohort study of 300 patients) ages 70 and older undergoing major elective surgery with evidence of confusion in their medical charts. Eight keywords or phrases had positive predictive values of 60% to 100% for delirium. Keywords were charted more often in nursing notes than physician notes. A brief list of keywords may serve as a building block for a methodology to screen for possible delirium from charts, with particular attention to nursing notes, for research and real-time clinical decision making.

Rights and Permissions

Citation: J Gerontol Nurs. 2015 Aug;41(8):34-42. doi: 10.3928/00989134-20150723-01. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Journal of gerontological nursing

PubMed ID

26248142