Microteaching to improve delirium screening and recognition in older surgical patients

Introduction
Delirium is a common but serious complication in older surgical patients, associated with increased morbidity and mortality, prolonged length of stay and poorer long-term outcomes. NICE guidance recommends all patients are observed daily for signs of delirium and promotes a multidisciplinary approach to prevention and management. The diagnosis and documentation of delirium is important for coding, handover of care and for helping patients and families understand their symptoms. 

Methods   
Clinical notes of patients aged ≥65 discharged from general surgery in January 2025 (n = 38) were audited for screening, identification and documentation of delirium and its risk factors. A teaching session on delirium was delivered by a Geriatrics registrar to resident doctors in general surgery, and posters summarising features of delirium were displayed on the ward at notes stations and in the doctors' office. Patient notes from July 2025 (n = 46) were then audited.

Results   
The percentage of patients who had delirium risk factors identified increased from 10% in January to 40% in July. Patients with documented signs of delirium increased from 20% to 38%. Patients with a documented delirium diagnosis increased from 10% to 19%, of which 33% and 40% (respectively) had the diagnosis included in their discharge summary. No patients were consented for delirium as a post-operative complication in either cycle.  Use of the 4AT delirium screening tool remained low despite our intervention, being used in 6.7% (January) and 3.8% of cases (July).

Conclusion   
 Simple interventions such as teaching and posters improved delirium identification and documentation. However, the use of formal screening tools and the practice of consenting for delirium as a post-operative complication remain areas for improvement. The next steps are to include the teaching session in the surgical resident doctors’ induction and design a modified ward-based session for nursing staff and other MDT members.