Developing a tool to improve the identification of the causes of delirium in the acute setting

Delirium is an acute, fluctuating syndrome of encephalopathy causing disturbed consciousness, attention, cognition, and perception. Development of delirium significantly increases morbidity, mortality, length of hospital admission, risk of readmission, and risk of institutionalisation on discharge. National data suggests that delirium affects up to 50% of patients in UK acute hospitals over the age of 65 (NICE 2010).

It is well established that the fundamental management of delirium is the identification and treatment of underlying pathophysiological causes. The causes of delirium are varied and often multifactorial, requiring a comprehensive assessment of any newly confused patient.

A local audit of our inpatient elderly-care ward population identified as developing a delirium (24 patients), showed that once a cause of delirium was identified (commonly infection), further investigations into alternate or additional causes (including constipation, nutrition/hydration, electrolyte abnormalities, urinary retention, medications, alcohol withdrawal) were often not considered. We identified at least 1 potential missed cause of delirium in 42% of patients audited.   

Therefore, we have created a simple but comprehensive tool using our trust’s Electronic Patient Record to support clinicians in the assessment of delirium and early identification of its underlying causes.

Post-intervention results analysis is ongoing but early data suggests an increase in the proportion of common causes considered/investigated for, resulting in a greater number of identified causes, and fewer missed causes.

Early identification of all causes contributing to patients’ delirium should allow for earlier treatment, thus improved patient outcomes and shorter length of inpatient hospital admissions.