Objectives: It has been demonstrated that a series of strategies supervised by a geriatrician can reduce the incidence of delirium in elderly hip fracture patients. The aims of this project were to determine if a geriatric registrar could introduce these strategies and alter the incidence of delirium in our orthopaedic unit.
Methods: The program used quality improvement methods and included staff education and the use of a checklist to facilitate the use of the strategies. We counted the number of recommendations made, the subsequent adherence to the recommendations and the before and after monthly incidence of delirium.
Results: The geriatric registrars made 424 recommendations (average six per patient) during a 3‐month intervention period, of which 89.9% were adhered to. Baseline data indicated an incidence of delirium of 10/28 cases (35.7%). Following introduction of the strategies, subsequent monthly incidences of delirium were 4/28 cases (14.3%), 3/22 cases (13.6%) and 2/21 cases (9.5%) (P < 0.035 compared with baseline).
Conclusions: We conclude from this short program that methods proven to prevent delirium can be introduced into routine clinical practice and that this appears to prevent cases of delirium.
The optimal model of care for patients with delirium in tertiary institutions is unknown. The aim of this project was to assess whether managing delirious patients in a secure unit could improve quality of care without significantly increasing the cost. We set up a delirium and surveillance unit at a tertiary hospital in Western Australia. The key elements of the unit were to provide a secure environment with staff trained and committed to delirium care. Patient care was based on comprehensive geriatric principles. The activities and outcomes were audited over an initial period after the establishment of the unit and a second audit was conducted following improvements based on the results of the initial audit. Managing patients in a delirium unit improves quality of care of patients and is cost-effective. The best model appears to be one where there is a dedicated consultant-led unit with ongoing staff education.
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