172 Using the early identification and management of delirium to optimise memory pathway referrals and resources

Abstract

Abstract Background Priority actions within the National Dementia Strategy are to ensure early diagnosis of dementia and to develop appropriate referral pathways and interventions to support patients. One element is the consideration of referral to memory services for patients who develop delirium within the acute hospital setting, which may suggest possible underlying cognitive impairment. We examined the effect of early identification and diagnosis of delirium via an inpatient frailty service on this process. Methods Over a 9-month period (September 2022–May 2023), patients >75 years admitted to the acute medical floor were screened with the Rockwood Clinical Frailty Scale (CFS) by a multi-disciplinary in-patient frailty team. Those with a CFS score of 5–6 (mild to moderate frailty) were prioritised for Comprehensive Geriatric Assessment (CGA), which included the 4AT delirium screening tool. Patients presenting with a 4AT of 1–3 indicating cognitive vulnerability and those with a 4AT of >4 suggesting a probable delirium with possible dementia were identified for assessment. Results 3,200 patients >75 years were admitted to the medical floor during the 9 months. Over 2,100 patients were screened for mild to moderate frailty and 495 CGA’s were completed. 105 patients presented with a 4AT of >4 with 44% not having a formal diagnosis of cognitive impairment. 74% of this cohort were referred onward to memory streams. 143 patients presented with a 4AT of 1–3. 66% did not have a formal diagnosis of cognitive impairment, of which 61% were referred onward to memory services. Conclusion The development of delirium in the acute hospital setting is an important opportunity to assess for the presence of an underlying neurodegenerative process. Early identification and management pathways for delirium can allow timely initiation of referral to specialist memory streams to aid prompt diagnosis of dementia, facilitating optimisation of care, supports, and advanced planning.