The Power of Two Questions: A Simplified Approach to Delirium Detection
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Publication Date
4-29-2026
Keywords
oregon, psvmc, psvmc gme, psvmc oaa
Disciplines
Medical Education
Abstract
Background: Delirium affects one-third of general medical patients aged 70 or older. Patients with older age, preexisting dementia, or cognitive impairment are at increased risk of developing delirium. Delirium is associated with increased length of stay, mortality, transfer to skilled nursing facilities, and costs. Although the Confusion Assessment Method (CAM) is a validated tool for delirium, its sensitivity can be low when administered by nurses because of its subjective nature and the need for formal training. The Ultra Brief Confusion Assessment Method (UB-CAM) is an objective, two-question test administered in 30-35 seconds compared to 5-10 minutes for CAM. The objective was to increase the combined delirium detection rate from 12% to 25% by July 1, 2025. Methods: The UB-CAM was implemented as a daily delirium screening tool for all patients aged 65 and older on the Medical A unit. Nurses on Medical A received training on delirium recognition and the proper use of the UB-CAM. A new workflow was established for nurses to report positive screens to the medical team for further evaluation. The primary outcome was measured by the percentage of patients on Medical A who had a positive delirium screen, which was assessed at admission and daily by RNs using the UB-CAM. Results: 605 adults aged 65 and over were screened out of 1,286 eligible for a screening rate of 47%. The UB-CAM combined positive rate on Medical A from June 2024 to July 1, 2025, was 54% (324/605). On a comparable unit (Medical B) during the same time, 1338 adults age 65 and over were screened with the CAM out of 1,677 eligible for a screening rate of 80%. Of those screened, 9% (116/1338) screened positive. Conclusion: The implementation of UB-CAM, paired with nurse education, successfully improved delirium detection compared to existing screening protocols. A decrease in RN screening may reflect nurses becoming more attuned to delirium, leading to more targeted screening. Assuming 30 seconds per UB-CAM and 5 minutes per CAM, the positive delirium screen rate per minute was 0.84 for UB-CAM and 0.024 for CAM. This means that in a single hour of RN screening time, UB-CAM positively screens 50 patients with delirium, while CAM only positively screens 1. A quick screening test allowed for earlier intervention with a physician order panel providing standard non-pharmacological treatments, including environmental and adaptive changes to reduce long-term morbidity. The simplified approach was well received by bedside nurses. Ongoing work is underway to build the UB-CAM into the electronic health record at four additional units at two hospitals, as part of a larger system-level effort to adopt Age-Friendly care. Future steps will analyze patient outcomes, including length of stay and transfer to skilled nursing facilities.
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Internal Medicine
