Abstract
Background
Delirium is common in hospitalised older adults. It is distressing and devastating. Unfortunately, delirium remains under-recognised in clinical practice.
Methods
We conducted a multi-centre crowdsourced quality improvement project, with three rounds of data collection. We shared guidelines, toolkits, and educational tools in web-based folders, alongside social media and conference dissemination. We recorded delirium screening completion within 48 hours of admission and delirium recognition by the usual care team in unscheduled admissions (≥65 years). Delirium was diagnosed prospectively in Round-1 (R1) and Round-3 (R3), and retrospectively in Round-2 (R2) (validated approach).
Results
Across all rounds (82 sites), delirium prevalence was 16.3% (491/3013). Delirium screening (R1: 27.3%, R2: 29.6%, R3: 37.1%; p < 0.001) and recognition (R1: 34.2%, R2: 57.1%, R3: 63.2%; p < 0.001) improved across each round. Odds of screening (OR 1.52, CI 1.19–1.93) and recognition (OR 3.65, CI 1.94–6.87) were greater in R3 compared to R1 in multivariable analysis. Likelihoods of delirium screening (OR 0.49, CI 0.28–0.85) and recognition (OR 0.15, CI 0.03–0.82) were reduced in patients admitted under other surgery specialties. Local delirium teams were associated with increased screening odds (OR 1.75, CI 1.40–2.18), and geriatrics teams embedded into admissions units were associated with increased recognition odds (OR 1.66, CI 1.03–2.69). Documentation of delirium on discharge summaries also improved (R1: 28.6%, R2: 48.4%, R3: 46.6%). Odds of discharge documentation (OR 3.19, CI 1.18–8.82) were greater in R2 compared to R1 in multivariable analysis. Across all rounds, delirium was associated with increased hospital mortality (HR 1.83, CI 1.30–2.60) and length of stay (+3.18 days; p < 0.001) in multivariable analysis.
Conclusion
Delirium is common across all specialties. It is associated with increased mortality and length of stay. Trainee-led quality improvement crowdsourcing can be used to improve delirium screening, recognition, and documentation on discharge summaries.