Abstract
Background Delirium is an acute impairment of attention and cognition, precipitated by physiological stressors (Wilson et al., Nature Reviews, Disease Primers, 2020, 6(1)), associated with adverse outcomes (Huraizi et al., Journal of Clinical Medicine, 2023, 12(16), p. 5346) and often under-diagnosed in hospital (Lochlainn, Frewen and Bryant, Age And Ageing, 2018, 47(suppl_5), pp. v1–v12). Integrating early assessment into clinical practice is vital (Hopper et al., Geriatric Medicine GIRFT, 2021). This project assessed compliance with delirium guidelines from the National Institute for Health and Care Excellence (NICE) and Geriatric Medicine Getting It Right First Time (GIRFT), and introduced a cost-effective, easily embedded ward-based intervention to improve adherence. Methods This single-centre, retrospective observational audit was conducted on a 28-bedded Acute Senior Health Unit (ASHU) at our hospital. A previous cohort of trainees demonstrated statistically significant improvement in formal delirium assessment using education-based interventions (Cycle 1; C1). We re-audited the sustainability of this change and consequently introduced a digital admission proforma (Cycle 2; C2) to expand on this work. This incorporated the 4-AT assessment and prompting completion of an electronic assessment. This proforma’s impact was evaluated. All data was anonymised. Results 71 patients were included in C2. Re-audit of C1 showed a decline in patients receiving a formal delirium assessment with 4-AT (56.6% to 8.3%), while delirium diagnoses increased (27.6% to 66.7%). Following proforma introduction, delirium assessment increased (8.3% to 34.0%, p<.05) however this was associated with a concurrent decline in formal delirium diagnoses (66.7% to 44.7%). conclusions an easy-to-access, low-cost digital intervention may be useful tool improve assessment. however, project demonstrates the challenges of sustaining change across multiple cycles and trainee rotations. single is unlikely ‘silver bullet’ aligning practice national guidelines. continual re-audit necessary ensure sustainability.