Delirium is under-reported in discharge summaries and in hospital administrative systems: a systematic review

Temi Ibitoye, Sabrina So, Susan Deborah Shenkin, Atul Anand, Matthew J Reed, Emma RLC Vardy, Sarah T Pendlebury, Alasdair M J MacLullich

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Accurate recording of delirium in discharge summaries (DS) and hospital administrative systems (HAS) is critical for patient care.
To perform a systematic review of studies reporting the frequency of delirium documentation and coding in DS and HAS, respectively.
Medline, Embase, PsycINFO and Web of Science databases were searched from inception to 23 June 2021. Eligibility criteria included requiring the term “delirium” in DS or HAS; documentation in inpatient records alone was excluded. Screening and full-text reviews were performed independently by two reviewers. Risk of bias (RoB) was assessed using the Effective Public Health Practice Project tool.
The search yielded 7,910 results; 24 studies were included. The studies were heterogeneous in design and size (N’s=25 to 809,512). Mean age ranged from 57 to 84 years. Studies formed two clear groups. One group did not use additional delirium ascertainment methods and reported overall DS documentation and HAS coding in entire hospital or healthcare database (N=4). The second group used additional delirium ascertainment methods (e.g. chart review) in smaller subsets of patients and reported overall DS and HAS rates in relation to study-ascertained delirium rates (N=20). Studies reported either DS figures only (N=8), HAS figures only (N=11), or both (N=5). Documentation rates in DS ranged from 0.1% to 63.6%. Coding rates in HAS ranged from 1.5% to 48.7%. Some studies explored the impact of race, and nurse versus physician practice. No significant differences were reported for race; one study reported that nurses showed higher documentation rates in DS relative to physicians. Most studies (N=22) had medium to high RoB.
Delirium is a common and serious medical emergency yet studies show considerable under-documentation and under-coding. This has important implications for patient care and service planning. Healthcare systems need to take action to reach satisfactory delirium documentation and coding rates.
Original languageEnglish
Early online date15 May 2023
Publication statusE-pub ahead of print - 15 May 2023


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