Abstract
Introduction
Delirium is a common presentation in frail, older, hospitalized patients (approximately 25% of admissions, with 50%+ on surgical wards), with a high mortality (approximately 22% during the hospital stay) with more associated, avoidable deaths than sepsis. Delirium is underdiagnosed. The National Institute for Health and Care Excellence (NICE) recommend using a validated screening tool on all patients at risk or showing evidence of delirium. “Getting it Right First Time, Geriatric Medicine” recommends all patients aged 75 or more, should be assessed using the 4AT tool (a validated delirium screening tool).
Method
A delirium pathway was developed in University Hospital Morecambe Bay Trust to embed these recommendations. A program of learning events was devised to target all grades of doctor along with a poster with the byline “Test it, Type it, Treat it”, included in multiple presentations and in trust screensavers.
Results
Before the education program, the Frailty Intervention Team (FIT) assessed patients for potential early discharge used the 4AT in 80.85% of patients with a diagnosis of delirium coded in 11.12%. In patients not seen by FIT (nFIT) the 4AT usage was 25.18%, with a delirium diagnosis rate of 9.11% Following the education program FIT 4AT usage was 96.12% with 18.69% diagnosed with delirium. The nFIT cohort completed 4AT in 33.63% of patients with 12.63% diagnosed with delirium. Analysis with Statistical Process Control charts showed that after the education program the use of 4AT by inpatient teams improved (p<0.05), but not in the Emergency Department (ED).
Conclusion
FIT assessed and diagnosed more patients than nFIT both before and after the intervention, with both groups showing improvement following the educational package. There is scope for improvement and further education events are planned, especially with ED, engagement of the ward “frailty champions” and possibly mandating the electronic 4AT.