Abstract
Introduction: Delirium is a neuropsychiatric condition which is independently associated with poorer outcomes, and is prevalent in those aged over 75. Early recognition and standardised pathways are key to delivering good delirium care. Despite this, there are no formal screening and standardised pathways in RIE ED. Baseline data suggested around 4% are being screened for delirium.
Aim: To increase screening for delirium from a baseline figure of 4% to 75% for patients aged over 75 years of age attending RIE ED, and also to ensure initial investigations were initiated in any patients who were found to be delirious on screening by the end of April 2022.
Method: With help from the project supervisor, a project driver diagram was produced. In combination with baseline data and pre-intervention surveys, the change ideas were formed. These were then tested through the Model for Improvement approach.
Results: In summary, a total of 25% of patients sampled had a 4AT completed.
Conclusion: Although the results fell short of the goal by a distance, it represented a significant improvement compared to the baseline. The improvement was proven to be sustained throughout a period of 62 days, across 2 PDSA cycles. Further analysis revealed significant variations in daily results. Strategies to decrease variations include further education and increasing accessibility to delirium care (e.g. standardised pathways). It is hypothesised that these strategies will be able to instil a stronger departmental culture which focuses more on delirium care and hence will form the basis of future PDSA cycles.