Improving Early Recognition of Delirium within University Hospital Ayr

Delirium affects approximately 30% of medical inpatients over 65 and has an associated mortality rate of approximately 39%. Although one third of cases are preventable, delirium remains under recognised, delaying integrated care and prolonging admissions, leading to poorer patient outcomes. 

Aim - to evaluate diagnosis of delirium in patients aged ≥65 with an admission 4AT score of ≥4. To improve awareness of delirium and encourage completion of a ‘delirium screen’. 

Eligible patients were identified across four downstream medical wards within University Hospital Ayr. Medical notes were reviewed, assessing documentation of ‘delirium’ diagnosis relative to time of admission. Completion of additional documentation, including functional and collateral history, Adults with Incapacity, stool chart and delirium screen, was also evaluated. Teaching sessions were delivered and posters located throughout medical receiving. Focused teaching sessions were delivered to Foundation Doctors and senior nurses. Finally, a delirium screen sticker was created. Data was reviewed and collated throughout cycles. 

Following teaching, documentation of delirium improved by 22%. Capacity assessments were readily completed prior to this project but AWI use improved by 3%. Foundation trainee teaching vastly improved completion of functional and collateral histories. However, establishment of legal powers occurred in only 35% suggesting further education is required. Although delirium screening improved, this was not felt attributable to the delirium sticker. Stool chart completion remained suboptimal likely reflective of nursing workload. 

Delirium diagnosis remains delayed despite use of a validated screening tool upon admission and early recognition of incapacity. Teaching delivered positive results yet these may be enhanced if delivered as part of an MDT programme. An electronic delirium screen may be more efficient. Consideration should be given to the sustainability of a 'delirium screen'.