Delirium: diagnosed on the ward, forgotten on discharge?
Abstract
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.
Comments
Do you think adding an…
Do you think adding an automated prompt or mandatory delirium documentation within the discharge process would be more effective than relying on education and posters
Yes adding an automated…
Yes adding an automated prompt or mandatory delirium documentation within the discharge process would potentially result in further improvement, however, it is difficult to say if it would be more effective than relying on educational awareness and posters. This was explored with the Trusts IT department, however, the request was refused due to the trust's impending transfer to a new online digital EPR system (EPIC), therefore adding such prompts onto the old systems was deemed not feasible. However, the posters and educational sessions have led to consistent sustained improvement over several cycles of intervention, as shown in the graphs under results in the poster. Adding a prompt as another intervention or change and having it assessed through a PDSA cycle would potentially lead to even greater improvement and consequently improved continuity of care on discharge for delirium patients into primary care. This highlights the potential for this project to be carried on with further cycles, leading to even greater and more sustained improvement.