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Screening for delirium – now a standard approach

Published 05/04/2022

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Our first large-scale improvement partnership made screening for delirium in older patients part of our routine on admission. With impressive and wide-ranging results.

After our ground-breaking research revealed the true extent of delirium in hospital patients, it was a no brainer that this would be the first problem we would tackle through our new partnership with the Institute for Healthcare Improvement.

We were armed with the new evidence that 40 per cent of Victorian patients (>65 years) could have delirium, and research told us 30 to 40 per cent of those cases could be prevented.

This gave us the confident that introducing a simple screening measure to detect possible delirium could deliver great improvements in how it is prevented or managed.

We also assumed we would see other benefits in a reduction in harm as a result of undetected delirium – such as patient falls, or time spent in hospital.

Twenty-one health services joined us for the 12-month long initiative. They were handed resources to help them implement and embed a screening check for older patients within 24 hours of admission. And importantly, we coached them through how to measure, track and sustain change.

Ending in March 2020, participating health services increased patient screening from 44 per cent to 81 per cent a week.

At the same time, project teams tracked a downward trend in:

  • patient falls of 18 per cent – average falls reduced from 4.9 to 4.0 falls per ward, per month
  • decreased length of stay by 0.2 days – the median length of stay dropped from 6.52 days to 6.33 days.

Embedding an individualised care plan for each patient was one of the standout achievements of the initiative, significantly increasing over time – from 15 to 87 per cent a week. As well as helping the patient, these plans help the clinicians know more about the daily routines of those in their care.

Project teams shared lots of helpful resources – such as a Forget-Me-Not flower and the Top 5 tool – which have been adopted by other health services.

At least one health service has created a team of Behaviour of Concern educators to extend the focus on the effective management and prevention of delirium.

Read more about delirium prevention.

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