The Future Hospital: a blueprint for effective delirium care

Abstract

Newcastle University ePrints -eprint.ncl.ac.uk Richardson SJ, Fisher JM, Teodorczuk A. The Future Hospital: a blueprint for effective delirium care.Delirium remains the most common hospital complication. Occurrence rates are set to rise as the population ages and, despite being preventable and treatable, delirium continues to be under-recognised. Given the adverse outcomes associated with delirium and the considerable fi nancial burden, patients with delirium must be considered 'core business' for 21st century hospitals. We propose that the principles of care outlined by the Future Hospital Commission report provide an ideal blueprint for effective, evidence-based delirium prevention and management. In this context, we outline practical advice for clinicians to improve standards of care for patients with delirium in hospitals. Because negative cultural attitudes, coupled with a lack of ownership towards this highly complex group, remain a major challenge, we consider novel educational interventions that empower the multidisciplinary team. Further, improved outcomes for patients with delirium are likely to translate to wider benefi ts for the hospital population at large.

Delirium

“…Multiple reasons exist for under-diagnosis, including, amongst others, a general lack of delirium training at all levels including in undergraduate education 249 , attitudes such as the perception that delirium is not 'owned' by (that is, the responsibility of) certain specialties or groups of practitioners 250 , the use of imprecise alternative terms such as 'confusion' , and a lack of perception that delirium is important. It is now clear that successful implementation of delirium detection, treatment and risk reduction is a complex challenge 251 , requiring an educational programme addressing both attitudes and skills, supported by audit, and using tools with proven implementability and tailored to the population to be tested. A study using quality improvement methodology to develop a digital pathway demonstrated the promise of this combined approach to improve delirium assessment and detection 252 .…”