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Effect of delirium motoric subtypes on administrative documentation of delirium in the surgical intensive care unit

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Abstract

This study compares the proportions of surgical intensive care unit (ICU) patients with delirium detected using the Confusion Assessment Method for the ICU (CAM-ICU) who received administrative documentation for delirium using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, stratified by delirium motoric subtypes. This retrospective cohort study was conducted at a surgical ICU from 06/2012 to 05/2013. Delirium was assessed twice daily and was defined as having ≥1 positive CAM-ICU rating. Delirious patients were categorized into hyperactive/mixed and hypoactive subtypes using corresponding Richmond Agitation Sedation Scales. Administrative documentation of delirium was defined as having ≥1 of 32 unique ICD-9-CM codes. Proportions were compared using Pearson’s Chi-square test. Of included patients, 40 % (423/1055) were diagnosed with delirium, and 17 % (183/1055) had an ICD-9-CM code for delirium. The sensitivity and specificity of ICD-9-CM codes for delirium were 36 and 95 %. ICD-9-CM codes for delirium were available for 42 % (95 % CI 35–48 %; 105/253) of patients with hyperactive/mixed delirium and 27 % (95 % CI 20–34 %; 46/170) of patients with hypoactive delirium (relative risk = 1.5; 95 % CI 1.2–2.0; p = 0.002). ICD-9-CM codes yielded a low sensitivity for identifying patients with CAM-ICU positive delirium and were more likely to identify hyperactive/mixed delirium compared with hypoactive delirium.

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Acknowledgments

Investigators would like to thank Harlan Sparrow IV, MA (Senior Outcomes Analyst II, Quality, Houston Methodist System) and Bob Smith, MA (Epic Clarity Project Team, Houston Methodist System) for conducting queries of the electronic medical record to provide data for this study. The authors would like to thank Mary Thomas, MSN, RN (Manager, Clinical Documentation Management Program, Houston Methodist Hospital) and Tessie Bautista, CCS, (Health Information Management Manager, Coding and Data Management, AHIMA-Approved ICD-10-CM Trainer, Houston Methodist Hospital) for advising on administrative database and coding process. Investigators would like to thank the Department of Pharmacy at Houston Methodist Hospital for providing administrative, intellectual, and information technology support. Investigators would like to thank the Texas Southern University Undergraduate Research Program for the awarded stipend to Lan N. Bui to support her effort in the study.

Funding

LNB received an intramural grant from Texas Southern University, Houston, Texas, USA supporting her efforts on this study and a travel grant from Texas Society of Critical Care Medicine (SCCM) to present study result at SCCM Congress at Phoenix, Arizona, USA in January 2015. Other authors received no other financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Pharmacy, Houston Methodist Hospital, 6565 Fannin Street DB1-09, Houston, TX, 77030, USA

    Lan N. Bui & Joshua T. Swan

  2. Department of Pharmacy, Memorial Hermann Greater Heights Hospital, 1635 North Loop West, Houston, TX, 77008, USA

    Vy P. Pham

  3. Center for Outcomes Research, Department of Surgery, Houston Methodist Hospital Research Institute, 6565 Fannin Street, Houston, TX, 77030, USA

    Beverly A. Shirkey & Joshua T. Swan

  4. College of Pharmacy and Health Sciences, Texas Southern University, 3100 Cleburne St, Houston, TX, 77004, USA

    Joshua T. Swan

  5. Allied Health Sciences, Institute for Academic Medicine, Houston Methodist Research Institute, 6565 Fannin Street, Houston, TX, 77030, USA

    Joshua T. Swan

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  1. Lan N. Bui
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Correspondence to Lan N. Bui.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Bui, L.N., Pham, V.P., Shirkey, B.A. et al. Effect of delirium motoric subtypes on administrative documentation of delirium in the surgical intensive care unit. J Clin Monit Comput 31, 631–640 (2017). https://doi.org/10.1007/s10877-016-9873-1

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  • DOI: https://doi.org/10.1007/s10877-016-9873-1

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