Abstract
Introduction: Early identification and management of all contributory factors is vital in the management of delirium. Delay in investigation can lead to morbidity, mortality, longer length of stay or inappropriate discharge from hospital. We carried out a Quality Improvement project looking to ensure all patients with delirium had appropriate blood tests taken in the Emergency Department (ED).
Methods: For the first cycle, 25 patients > 65 years admitted through ED in December 2022 and January 2023 with delirium were identified based on medical clerking and post take ward round diagnosis. Patients who had a cause for confusion which was clearly known, for example sepsis, were excluded. Data analysis revealed the percentage of patients who had their calcium and CRP bloods checked within 12 hours of admission was only 20% and 76%, respectively. We introduced a simple change: adding bone profile and CRP to the “confusion button” on the ICE electronic requesting and reporting system. A second cycle of data collection was completed for a further 25 patients admitted with delirium between June and July 2023 to measure the effectiveness of the implemented change.
Results: From our initial analysis, only 20% of patients aged >65 years presenting with delirium had their calcium and 76% of patients had their CRP checked within 12 hours of admission. Following our intervention, we found that 88% of patients had their calcium and 96% of patients had their CRP checked within 12 hours of admission.
Conclusion: The amendment of the ‘confusion screen’ button, on the ICE requesting system in the hospital, resulted in a significant increase in the number of patents having appropriate blood tests within 12 hours of admission.
This QIP has resulted in earlier identification of potential causes of delirium and has therefore improved morbidity, improved mortality, reduced the length of hospital stay and reduced inappropriate discharges from hospital for patients presenting with delirium. Furthermore, given the lack of other specific symptoms associated with hypercalcaemia and the urgency of the diagnosis, our QIP could ultimately be life saving for patients presenting with hypercalcaemia.