Improving the Quality of Delirium Care in the MAU Using the TIME Bundle: A Quality Improvement Project

Abstract Content :

Background:
Delirium is a common but often under-recognized acute condition in hospitalized patients, associated with increased morbidity, length of stay, and healthcare costs. In Ysbyty Ystrad Fawr Hospital’s Medical Assessment Unit (MAU), a retrospective review of patients with a 4AT score ≥4 was done to find out deficiency in the assessment and documentation of delirium, as well as inconsistencies in key aspects of care.

Methods:
A quality improvement initiative was undertaken to enhance the recognition and management of delirium. A screening and documentation tool, the TIME bundle sheet (focusing on: T—Think triggers, I—Investigate, M—Manage, E—Explain), was introduced into the initial clerking proforma. This was supported by a series of educational sessions for junior doctors. The intervention emphasized monitoring and addressing factors such as blood glucose (BMs), hydration status, constipation, urinary retention, medication review, blood tests, and ECGs. Importantly, it also focused on ensuring the diagnosis of delirium was explained to both patients and their families and clearly documented.

Results:
Post-intervention data demonstrated a notable improvement in several domains of delirium care. In particular, there was a significant increase in the documentation of delirium as a diagnosis and in the practice of explaining the condition to patients and families, fostering better communication and awareness among all healthcare professionals involved. Compliance with core elements such as hydration, medication review, and identification of triggers also improved.

Conclusion:
The introduction of the TIME bundle has significantly improved the recognition, documentation, and holistic management of delirium in the MAU. Educating staff and embedding the bundle into standard clerking processes led to measurable enhancements in patient-centered care, communication, and multidisciplinary involvement. This project highlights the value of structured tools and education in improving delirium outcomes.