IntroductionDelirium is a serious medical condition that is common in older adults in acute settings. Clinical practice guidelines recommend that all older patients in acute care settings should be screened for delirium using standardised outcome measures.ProblemIn our institution, an audit showed that only 16% of older adults presenting to the emergency department were screened for delirium. The goal of this project was to increase the number of patients being screened for delirium using Lean Six Sigma (LSS) methodology and tools and a multidisciplinary approach.MethodA multidisciplinary team in the emergency department used LSS tools and methodology over a 12-week period to first identify why patients were not being screened for delirium using root cause analysis and second to implement a multifaceted intervention including education, audits and feedback, documentation changes and team huddles. An audit was performed at the 11th week of the project to measure how many patients were being screened for delirium post project intervention.ResultsResults at 5 weeks post intervention (11th week of project) showed that the percentage of patients being screened for delirium had increased from 16% to 82%. A follow-up audit at 17 weeks post intervention showed a further improvement in delirium screening to 92%.ConclusionApplying LSS tools and methodology resulted in a healthcare quality improvement. Delirium screening in an emergency department can be improved through multifaceted interventions including education, documentation changes and team huddle changes.
BACKGROUND: Head trauma can cause secondary benign paroxysmal positional vertigo (BPPV). BPPV is a common peripheral condition which can lead to significant morbidity, psychosocial impact and increased medical costs [1]. CASE DESCRIPTION: A patient post fall with an associated head trauma presented to the emergency department with severe vertigo, nausea, and decreased mobility. The patient was assessed and treated by a vestibular trained physiotherapist. The patient was treated with one Epley repositioning manoeuvre and had complete resolution of symptoms and was discharged home the same day. CONCLUSION: BPPV can be successfully identified and treated by vestibular trained physiotherapists in the emergency department. Early access to vestibular trained physiotherapy in the emergency department resulted in diagnosis and evidence-based treatment of BPPV which prevented hospital admission and improved this patient’s outcome. The patient had complete resolution of symptoms post the repositioning manoeuvre and was discharged to home.
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