This report published by the Royal College of Psychiatrists provides a full breakdown of results from a national audit focusing on the identification and assessment of delirium in general hospitals. It also includes key findings, recommendations, and a discussion of results.
A high proportion of patients with dementia admitted as emergencies to hospital did not receive an initial assessment for delirium, even after adjustment
After taking account of the greater number of initial assessments identified by the additional questions included in the questionnaire, we found that 32% of patients with dementia, admitted to hospital as an emergency, did not have an initial assessment or screen for delirium. At just under one third of the sample, this remains a very high proportion of people at high risk of delirium and requires improvement.
Questions about initial screen or assessment for delirium are inconsistently interpreted
Variation is apparent in the approach hospitals take to carrying out and recording the assessment of delirium, as questions about an initial screen or assessment for delirium are inconsistently interpreted. In 219 (10%) casenotes, auditors reported no screen, but questions about specific assessments found that it had taken place. Following adjustment allowing for responses for the follow up questions, results for individual hospitals improved by an average of 19% with individual hospitals seeing increases ranging from to 64 percentage points.
Over a quarter of patients have no confusion or cognitive tests recorded
37% of patients received no confusion or cognitive tests at all, as well as no initial screen. Cognitive assessment is an important part of comprehensive assessment which all patients with dementia admitted acutely should receive.
Delirium not included in discharge correspondence
Only 48% of patients whose casenotes recorded possible delirium at admission or after initial screening had this recorded on their discharge letter or summary. All patients who have delirium during admission to hospital should have this information communicated to their General Practitioner (and Primary Care team) on discharge.