Neurological Orientation and Verbal Assessment of Delirium-Hospital Clinical Decision Support Tool.

Abstract

Importance: Delirium is a complex medical condition that is underdiagnosed. We present findings of a novel electronic medical record (EMR) clinical decision support tool called the Neurologic, Orientation and Verbal Assessment of Delirium (NOVAD) that can optimize delirium identification and management. In this retrospective observational study, we report the performance of NOVAD as a clinical decision support tool for delirium.

Objective: We present an innovative EMR based clinical decision support tool for delirium called NOVAD. NOVAD utilizes variables from nursing assessments that are documented in EMR consistently and accurately. We aim to study the NOVAD (sensitivity, specificity, and predictive value) ability in detecting delirium among hospitalized adults and assess its potential as a clinical decision support tool for delirium.

Design: A retrospective observational study of consecutive hospital admissions to Banner Health System between January 1, 2020, and December 31, 2020. 464,395 participants were included in this study. The mean age of study participants was 56.18 years (SD 20.82), with 56.2% women (n = 260,856).

Results: NOVAD was 86.6% sensitive (95% CI 86.5, 86.7) and 78.1% specific (95% CI: 77.9, 78.2) based on ICD-10 diagnosis codes for delirium. The positive predictive value for NOVAD was 33.5% (95% CI 33.3, 33.6) and the negative predictive value was 97.8% (95% CI 97.8, 97.9).

Conclusions and relevance: We demonstrate that an innovative EMR tool that leverages nursing assessments, NOVAD, has the potential to be used as a clinical tool to predict and screen for delirium in hospitalized adults.