601 Improving Delirium Assessment in a District General Hospital

Abstract

Introduction Delirium affects a up to 20% of medical inpatients1. Patients in the high-risk category include those over 65, pre-existing cognitive impairment, current hip fracture and those with a serious illness 1,2. Often delirium goes undetected but is often related to high morbidity and motility rates with complications of insitionalisation, increased risk of dementia, high risk of falls and prolonged hospital stays1,2, recognition is the first step to reducing these risks. NICE guidance suggests that those patients showing indicators of delirium should have a formal cognitive assessment and a tailor-made plan should be documented within 24 hours 2. The detection of delirium can be sort using licensed tools including the 4AT score with the 4AT being the most sensitive, specific and practical1. Due to the ongoing risks of delirium, high risk patients on the Geriatric medicine firm and poor detection rate a quality improvement methodology was used to increase the rates of detection of delirium. The aim to have 90% of Geriatric medicine patients screened within 24 h admission and within 24 h of arrival to COTE ward/first consultant ward round within 4 months. Method 4 PDSA cycles were designed to trial changes including education of the Geriatric medicine team, lanyard cards, introduction of 4AT on the frailty proforma and a non-intervention cycle to see if these changes were sustained. Data was collected from the care of the elderly ward not including outliers of 27 patients. Any formal cognitive assessment that was documented either on admission or on arrival to the ward was included. Not included was those patients who were assessed for delirium or change in cognition after first consultant ward round or after 24 h of being on the ward. Results The uptake of 4AT improved by 50% after education and the lanyard cards. This was largely as a shift away from other assessments rather than more cognitive assessments done overall. During service redesign an Older Person’s Assessment Unit was formed with a Geriatrician based at the front door. This will improve the use of the 4AT for older patients admitted to hospital in the near future and is the subject of the next PDSA cycle. Conclusion Our journey to embed the 4AT is ongoing and we will continue to improve uptake using QI methodology.