How to Screen Hospitalized Patients for Delirium Risk
How should clinicians and inpatient teams identify hospitalized patients who need structured delirium surveillance?
Hospitalized older adults and medically ill patients often develop delirium, which is associated with worse outcomes and may be missed without a systematic process. This guide applies to inpatient settings using the assessment workflow described in Effects of Intravenous Hydroxyzine Versus Haloperidol Monotherapy for Delirium: A Retrospective Study.
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Identify baseline delirium risk at admission
Assess all inpatients before or at the time of admission for the risk factors specified in the article's hospital workflow. These include age 70 years or older, definite or suspected dementia, a history of delirium, a history of stroke, current benzodiazepine use, and alcohol intake of more than 60 g of pure alcohol per day.
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Check for direct precipitants in high-risk patients
If a patient is considered at high risk for delirium, assess for the direct factors listed in the article. These are acute infection, hyperinflammation, acute hypernatremia or hyponatremia, hypoxemia, hypercapnia, and use of drugs that pose a risk for delirium.
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Perform CAM or CAM-ICU twice daily when indicated
For patients with direct factors for delirium or with suspected delirium, have trained nurses administer the Confusion Assessment Method or the Confusion Assessment Method for the Intensive Care Unit. The article describes assessments being done twice a day, in the morning and evening.
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Define delirium onset from the first positive screen
Treat a positive CAM or CAM-ICU result as the study definition of delirium. The date of delirium onset is the day on which the CAM or CAM-ICU first becomes positive.
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Continue surveillance until sustained resolution
Continue morning and evening CAM or CAM-ICU assessments until results are negative for 3 consecutive days. In the article, 3 consecutive negative days defined improvement of delirium.
Clinical Considerations
- This workflow reflects practice at a single hospital and was described as part of routine care rather than tested as an independent intervention.
- The article defines delirium and improvement operationally by CAM or CAM-ICU results, so applicability depends on trained staff using those tools consistently.
- The study excluded benzodiazepine withdrawal delirium and patients at high risk of alcohol withdrawal delirium from its treatment comparison.
Bottom Line
Use admission risk stratification plus twice-daily CAM or CAM-ICU monitoring in high-risk or symptomatic inpatients, and define improvement only after 3 consecutive negative days.
