Delirium: diagnosed on the ward, forgotten on discharge?

Introduction

Upon conducting a baseline audit assessing Colchester Hospital’s Care of the Elderly (COTE) wards’ adherence to NICE Quality Standard 63 — which states adults must have their diagnosis of delirium communicated to their GPs on discharge — it was found that compliance with this standard was suboptimal. This adversely impacts continuity of care.

Data was collected across four COTE wards (Tiptree, D’Arcy, Birch and Peldon) for December 2023. Out of 80 patients, only 34 had their diagnosis communicated to GPs, meaning only 42.5% adherence to NICE guidance. This highlighted a clear gap in quality of care.

Method

Driver diagrams, fishbone diagrams and process maps were utilized to identify change ideas, which were assessed through multiple PDSA cycles.

Interventions included an educational campaign through presentations at governance meetings, poster design and display across COTE wards, and expansion of posters to the doctors’ mess and multiple wards. Ward sisters and specialty matrons were involved to reinforce awareness during board rounds.

Further educational sessions were delivered during departmental teaching. Data was collected across April and May 2025 to assess improvement.

This project was conducted as a quality improvement initiative within a single NHS Trust using anonymized data.

Results

Following implementation of interventions, the rate of documentation improved from 42.5% at baseline to 56% in April 2025 and 69% in May 2025.

This demonstrated sustained improvement across two cycles, approaching the predefined target of ≥70%.

Conclusion(s)

Delirium is often under-recognized and under-communicated on discharge, which adversely impacts continuity of care.

Educational interventions alone were not sufficient; sustained improvement required multidisciplinary involvement and reinforcement within routine clinical practice.

This project demonstrated that low-cost interventions can lead to measurable improvement, but long-term sustainability requires embedding changes into everyday workflow and system-level support.