The Ultra-Brief Confusion Assessment Method (UB-CAM) is a two-step delirium screening protocol designed for rapid and accurate identification of delirium in hospitalized older adults. It combines the Ultra-Brief 2-item screen (UB-2) with the 3-Minute Diagnostic Assessment for the Confusion Assessment Method (3D-CAM), incorporating a skip pattern to enhance efficiency.

Key Features

• Step 1: UB-2 Screen
  A quick assessment involving two questions to rule out delirium. If the patient passes this screen, no further assessment is needed. If they fail, they proceed to Step 2.

• Step 2: 3D-CAM with Skip Pattern
  A brief cognitive assessment that evaluates features of delirium. The skip pattern allows for omitting questions if earlier responses indicate a positive result, reducing time and cognitive load.

Implementation and Performance

• Feasibility and Efficiency
  In a study involving 527 hospitalized older adults and 399 clinicians (hospitalists, nurses, and certified nursing assistants), the UB-CAM was successfully completed in 97% of cases. The average time to administer the UB-2 was 62 seconds, and the full UB-CAM protocol took approximately 104 seconds for nurses and 106 seconds for physicians. 

• Accuracy
  The UB-CAM had an overall accuracy approaching 90%. The UB-2 demonstrated sensitivities of 88% for certified nursing assistants, 87% for nurses, and 82% for physicians, with specificities ranging from 64% to 70%. 

Cost Analysis

A comparative salary-related cost analysis revealed that the average cost per screen was lowest for certified nursing assistants ($0.37), followed by nurses ($0.73), and hospitalists ($2.39). Utilizing a combined CNA-nurse approach further reduced costs, with a simulated protocol costing $0.78 per screen.