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Abstract
Key summary pointsAimTo seek information on delirium assessment processes and pathways in non-intensive clinical care settings in the United Kingdom (UK), and to assess usage of specific delirium assessment tools: the 4 'A's Test (4AT), Confusion Assessment Method and Single Question to identify Delirium (SQiD).FindingsIn total, 95% of National Health Service (NHS) units (hospitals, trusts and health boards) reported use of formal delirium assessment processes and 85% of units had guidelines or pathways in place. The 4AT was the most widely used tool, with 80% of units reporting use; the Confusion Assessment Method was reportedly used in 45% of units and the SQiD in 36% of units.MessageThis study shows real-world, large-scale uptake of delirium detection methods and delirium guidelines in UK hospitals, which contributes to ongoing efforts to improve delirium care.
Highlights
Delirium is a serious acute neuropsychiatric disorder of arousal, attention and cognition [1]
A further 11 acute units in England reported that such pathways or guidelines were under development. This United Kingdom (UK)-wide study with a high response rate of 91% found that 95% of units reported uptake of formal delirium assessment processes
With respect to the tools used, the 4 ‘A’s Test (4AT) was the most widely used tool, with 80% reporting use, followed by the Confusion Assessment Method (CAM) in 45% of units and the Single Question to identify Delirium (SQiD) in 36% of units
Summary
Delirium is a serious acute neuropsychiatric disorder of arousal, attention and cognition [1]. It is independently associated with multiple poor outcomes, including higher mortality, new dementia and patient and carer distress [1–4]. Delirium affects > 15% of hospitalised patients, yet it remains under-detected in routine clinical practice [1, 5]. Detection is essential for the treatment of delirium, prompting the search for acute precipitants, and assessment and treatment of distress, managing delirium associated risks, and in communicating the diagnosis to patients and carers [1]. Formal detection of delirium in routine clinical practice at the earliest possible time point has been advocated in multiple guidelines. Knowledge of real-world practices on the use of such tools is essential in understanding of their implementability and may inform the content of future guidelines
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