Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Comparative Study Observational Study
Comparison of mental-status scales for predicting mortality on the general wards.
Altered mental status is a significant predictor of mortality in inpatients. Several scales exist to characterize mental status, including the AVPU (Alert, responds to Voice, responds to Pain, Unresponsive) scale, which is used in many early-warning scores in the general-ward setting. The use of the Glasgow Coma Scale (GCS) and Richmond Agitation Sedation Scale (RASS) is not well established in this population. ⋯ In ward patients, both GCS and RASS were significantly more accurate predictors of mortality than AVPU. In addition, combining GCS and RASS was more accurate than any scale alone. Routine tracking of GCS and/or RASS on general wards may improve the accuracy of detecting clinical deterioration.
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Delirium is common, morbid, and costly, yet is greatly under-recognized among hospitalized older adults. ⋯ We identified a single item with >80% and pair of items with >90% sensitivity for delirium. If validated prospectively, these items will serve as an initial innovative screening step for delirium identification in hospitalized older adults.
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Editorial Comment
Ultrabrief delirium assessments--are they ready for primetime?
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Late afternoon hospital discharges are thought to contribute to admission bottlenecks. We previously described an intervention that resulted in a statistically significant increase in the discharge before noon (DBN) rate on 2 inpatient medicine units. ⋯ Increasing the DBN rate correlates with admissions arriving earlier in the day and reductions in high-frequency peaks of ED admissions. Statistically significant improvements in DBN rates are sustainable.
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Review
The association between an ultrabrief cognitive screening in older adults and hospital outcomes.
Though often recommended, hospital cognitive assessment is infrequently completed due to clinical and time constraints. ⋯ Impaired performance on ultrabrief cognitive assessments of arousal and attention provide valuable insights regarding hospital outcomes.