665 NECK OF FEMUR FRACTURE: POST OPERATIVE DELIRIUM SCREENING

Abstract

Abstract Introduction Delirium is common yet preventable in hip fracture patients. Adverse implications include: increased length of admission, hospital acquired infection, functional decline and mortality. NICE/NHFD guidance recommends early assessment using the 4AT tool. We aim to assess compliance with this guidance and to identify and initiate changes to improve screening and patient outcomes. Method Two loop audit with data collection from NHFD and electronic patient records. Initial retrospective assessment of 77 patients over 3 months. Timing of assessment, who performed it, complications and length of hospital admission were recorded. Recommendations included: all members of MDT to complete 4AT, adding 4AT as a task on nursing and doctor handovers, posters on ward, incorporating 4AT into ward round, 4AT as instruction on operation notes and departmental education session on delirium. Second audit loop of 38 patients with comparable demographics (gender, age, cognitive impairment, AMTS and ASA) over 6 weeks to assess impact of recommendations. Results Out of the original 77, 14 patients were diagnosed with delirium. They had more complications (50% vs 23.8%), reduced discharge to own home (28.5% vs 46%) and increased mean length of admission (15.1 vs 11.2 days) compared to non-delirium group. Recommendations improved overall compliance from 79.3% to 92.1%. T&O team completed 15% of assessments in first loop, improving to 53%. Earlier completion of 4AT assessment (mean 2.11 to 1.63; median 2 to 1 days). Improvement in 4AT screening led to reduced rates of post-operative complications (40% vs 46%) and reduced length (days) of hospital admission (median 10 to 8.2); mean (11.8 to 8.5). Conclusion Recommendations improved 4AT compliance and proportion completed by T&O juniors (reducing burden on orthogeriatricians who only review patients 1–2 times per week). Greater compliance with 4AT screening in the post-operative period was associated with reduction of post-operative complications and reduced length of admission.