Abstract
Introduction:
Delirium, an acute neuropsychiatric syndrome, affects one in four hospitalised older adults. Effective management requires timely detection using validated tools and a structured approach to causes and sequelae. There is limited evidence on contextual factors surrounding assessment tool implementation and delirium management. The primary aim of this study was to describe the use of validated delirium assessment tools across Scotland, with a secondary aim of describing protocols for delirium management and barriers to implementation.
Methods:
This was a secondary analysis of national Scottish data from a global point-prevalence study conducted on World Delirium Awareness Day, March 15, 2023. Data were collected via an anonymous survey distributed through social media and professional networks, covering inpatients in acute hospitals, including ICUs, at two timepoints (8am/8pm). The survey collected data on the presence of delirium, delirium assessment tools used, management protocols, and barriers to effective delirium care.
Results:
A total of 120 survey responses were received from 13 hospitals, reporting on 3257 patients at 8am and 2436 patients at 8pm. Most respondents were doctors (72.5%). The most frequently reported assessment tool was the 4AT (75%), and 14.2% of units reported using personal judgement rather than a validated tool. The overall delirium prevalence was 22.3% at 8am and 23.2% at 8pm, with the highest rates observed in geriatric units. Most units had delirium management protocols, but reported barriers to implementing delirium assessment and management including staff shortages, lack of time and insufficient training.
Conclusion:
This study highlights widespread use of the 4AT for delirium assessment in Scotland. There is variation in existing delirium management protocols, and significant barriers remain to effective implementation. Findings emphasise need for ongoing awareness, education, and resources to improve delirium care. Future research should focus on developing delirium management protocols and exploring context-specific barriers to improve patient outcomes.