Abstract
BackgroundDelirium is more prevalent in older people and estimated to occur in up to 50% of the hospital population. Delirium comprises a spectrum of behaviours, including cognitive and attention deficits, and fluctuating levels of consciousness, often associated with an underlying physiological disturbance. Delirium has been increasingly associated with adverse outcomes. Although often preventable or can at least be mitigated, delirium may not be a standard part of assessment and thus may not be recognized in the early stages when it is most likely to be treated successfully. The aim of this study was to evaluate the level of knowledge of delirium amongst clinicians caring for patients at high risk of developing delirium and to determine whether education can improve clinical assessment of delirium.MethodsTwo hundred and forty-six case notes were audited before and 149 were reviewed after the education intervention and implementation of a delirium screening tool. Clinicians at the hospital were invited to complete a questionnaire on knowledge of delirium. The questionnaire was based on a validated tool which contained 39 questions about delirium. The questionnaire also contained 28 questions on delirium knowledge. Additional questions were included to gather demographic information specific to the hospital. Descriptive statistics, chi square and independent t-tests were conducted to test for differences in knowledge between the pre and post periods. The Squire Checklist Reporting Guidelines for Quality Improvement Studies informed the preparation of the manuscript.ResultsThe audit demonstrated that the use of a cognitive assessment tool overall increased from 8.5% in pre education to 43% in the post education period. One hundred and fifty-nine staff completed the questionnaire in total, 118 the pre and 41 post. The knowledge subscale score was high pre and post education and no statistically significant difference was observed. The greatest increase in knowledge was related to knowledge of the risk factors subscale. The increase in knowledge (6.8%) was statistically significant.ConclusionAn interprofessional approach to delirium education was effective in not only increasing awareness of the factors associated with this syndrome but also increased the use of a delirium assessment tool.
Highlights
Acute onset delirium is a distressing condition for both patients and their families and is becoming a significant issue within health care
In 2018 compared to 2017, the patients admitted to the hospital were younger in age, a higher percentage were males (5%), were 6% less likely to have a length of stay greater than 10 days and 4% less had a previous history of dementia (See Supplementary Table D for full descriptive statistics of the audit findings by year)
Delirium is still widely under recognised and managed within health care, and there is a pressing need to increase the recognition of delirium itself and of the predisposing factors
Summary
Acute onset delirium is a distressing condition for both patients and their families and is becoming a significant issue within health care. In recent years delirium has been increasingly associated with adverse outcomes [1], especially in older people [2, 3] These adverse outcomes include extended length of hospital stay [4], cognitive decline [5], increased re-admission rates [6], increased health care costs [6,7,8], functional decline and mortality [9, 10]. It is more prevalent in the older population and comprises a spectrum of behaviors, including cognitive and attention deficits and fluctuating levels of consciousness [11, 12] and can frequently be prevented or mitigated [13]. This controversy and lack of consensus around best practice in relation to the management of delirium presents challenges to researchers and clinicians [28]
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