246 Feasibility of a delirium intervention pathway by a frailty at the front door team

Abstract

Abstract Background Consistent success in reducing delirium incidence and related falls, cognitive and functional decline, length of stay, use of one-to-one supervision, institutionalisation, readmissions, and health-care costs (hospital and 1-year) has been demonstrated in delirium, with and without dementia. Intervention strategies reduce delirium and its adverse outcomes by 30–40%. Frailty at the Front Door (FFD) emergency department teams perform 4AT as a routine component of comprehensive geriatric assessment. The aim of this study was to benchmark delirium with and without dementia in patients assessed by a FFD team in an urban tertiary referral centre and assess feasibility of an FFD delivered inter-disciplinary delirium intervention pathway. Methods Age, gender, Clinical Frailty Score (CFS), 4AT, AD8 and dementia diagnosis recorded in 500 consecutive patients in a clinical excel database were analysed using descriptive statistics. An inter-disciplinary delirium pathway, consisting of blood tests, anti-cholinergic cessation, neuro-imaging, individualised patient, carer, staff education was embedded into practice and use of the pathway recorded over a subsequent 2 month period. Results Mean (SD) age was 83 (6.9) years. Female to male ratio was 1.5:1. Mean(SD) CFS was 5 (1.2), with CFS unrecorded in 10%. 91% (n = 456) had 4AT recorded. 50% (n = 230) had a 4AT of zero. 38% (n = 177) had a 4AT of 1–3. 25% (n = 114) had a 4AT of >/=4. Of those where dementia diagnosis was recorded, n = 74, 40% (n = 29) had a 4AT of >/= 4. Where AD8 was measured, 50%(n = 12) had a 4AT of >/=4. The delirium intervention pathway was applied to 16% (n = 70) of the total population over a 2 month study period. Conclusion 4AT>/4 was retrospectively benchmarked at 25% in this population. Recording of dementia diagnosis and AD8 was low. Targeting existing resources to prevent delirium resulted in two-thirds of the expected population benefitting from standardised delirium prevention. Dedicated delirium resources in acute hospitals will further improve outcomes.