594 - Clerking in Confusion

Abstract

Introduction:

Delirium is common but often under-diagnosed. Early detection and diagnosis are vital for better prognosis, placing emphasis on the quality of the admission clerking. NICE recommends using the Confusion Assessment Method (CAM) when assessing such patients. For a delirium diagnosis patients have to fulfill the CAM criteria.

Aim:

To establish if the CAM is a useful tool in clerking patients presenting with confusion.

Objectives:

1. Assess uptake of the CAM

2. Identify how many patients presenting with confusion fulfill diagnosis criteria

3. Determine if the CAM results in a lower number of amended diagnoses

4. Describe associations between clinical findings and diagnosis

5. Evaluate junior doctor knowledge about the CAM

Methods:

A prospective audit was performed to assess the quality of clerking in fifty patients presenting with “confusion’. The second phase involved a qualitative questionnaire to assess junior doctor knowledge of the CAM.

Results:

CAM was not used to make any diagnosis. Only 4% of clerkings fulfilled diagnosis criteria. Patients diagnosed with delirium, who then had their diagnosis amended, did not fulfill CAM criteria on admission. Junior doctor knowledge of delirium diagnosis was poor.

Conclusions:

The CAM is a useful and valuable tool, resulting in fewer unnecessary investigations and a reduced hospital stay. Junior doctor knowledge of it is inadequate explaining why it is not currently being used in practice. We recommend that the CAM should be included in the teaching curriculum. This study shows that further investigation of the aim, and its objective, is warranted and justified.