Optimising Delirium Pathways in Geriatric Care: The Impact of Consultant Led Old Age Psychiatry Liaison Service

Abstract

Abstract Background Delirium is a common and severe condition affecting up to 50% of older adults in hospitals. Delirium is compounded by the noisy and frightening environment of medical wards, often leading to prescription of antipsychotics. There is often no clear plan to monitor effects of these medications. Delirium is also associated with increased rates of institutionalised care on discharge, readmission rates and mortality. Methods This QIP examines the effectiveness of interventions for patients with delirium in COE wards, focusing on involvement of consultant led old-age psychiatry liaison service. This 2-cycle process included 106 patients in the 1st cycle (Feb 2020-Sep 202, nurse-led), and 64 patients in the 2nd cycle (Nov 2022-Aug 2023, consultant-led). Outcome measures the number of patients assessed, new antipsychotic prescription, new nursing home placement, follow-up plans, readmission rate, and 1year mortality. Results The QIP revealed an increase in the number of inpatients reviewed by the POA team (330%) and planned out-patient POA follow-up (320%). There was an increase in the number of antipsychotics prescribed on discharge (61.5%) and discharge to a new appropriate placement (27.6%). The overall readmissions rates had slightly decreased (2.5%), and readmissions with delirium had further reduced (4%) (not significant, p=0.66). The overall mortality rate increased by 4% since the introduction of these measures (not significant, p=0.63), however, this is small and at a level expected with this population group. Conclusion These results suggest that the new consultant led liaison team resulted in an increased use of their expert opinion on challenging patients with delirium. Significantly, more patients received psychiatric follow-up crucial for antipsychotic monitoring. There is a slight reduction in the readmission rates. Although, the increase in the mortality rate is insignificant, this warrants a closer look as antipsychotics are associated with cardiovascular diseases. A larger study over a longer period of time would provide more useful data.