1940 Delirium in acute medicine inpatients - are we still missing it? Results from an 8-year audit in a District General Hospital

Abstract

Abstract Introduction Improving delirium screening in hospital patients is a recognised important goal to improve patient outcomes, with consequences of delirium including increased mortality, falls, length of stay and dependence on discharge. We undertook a rolling audit over 8-years to examine the use of screening tools to identify delirium and how many cases of delirium were potentially missed in acute medical inpatients in a District General Hospital. Methods 4 cycles of audit were completed over an 8-year period (2015–2023) through a snap-shot prospective review of all acute medical inpatients aged over 65 years during a 24-hour period. The medical records were examined for admission delirium screen and the delirium documentation within the first 48 hours. Where a diagnosis of delirium had not been made, the notes were reviewed to see if an inference of delirium during this period could be made. Results A total of 873 patient notes were reviewed between 2015–2023. The completion rate of screening for delirium increased to 87% in 2023 (2015/2017/2019=3%/13%/69%). Overall, the diagnosis of delirium that was explicitly stated in the notes (made via CAM/4AT or clinical assessment) similarly increased to 32% in 2023 (2015/2017/ 2019=10%/22%/12%). However, in the recent results a delirium diagnosis was potentially still missed in 10% of cases, though this similarly had improved from prior years (2015/2017/2019=18%/13%/26%). Overall, in hospital the number of patients >65 admitted under the care of medicine with delirium in the initial 48 hours has remained constant since 2015 between 30%-42%. Conclusions A significant improvement in the screening for delirium has occurred between 2015 to 2023 due to multiple changes: electronic notes, pop-up notifications, obligatory completion and change from CAM to 4AT. Reassuringly, the potential missed cases of delirium have reduced also.