3033 Delirium epidemiology and outcomes—is there value in a delirium best practice tariff?

Abstract Introduction Delirium complicates 10% of admissions. A delay in diagnosis can lead to permanent cognitive decline, care home placement and death. Watford General Hospital’s (WGH) delirium liaison service receives fewer referrals than expected from areas with vulnerable patients such as ITU. This audit sought to understand why and what effect this might have on outcomes. Method The audit team reviewed notes for all >75-years-old in WGH on a single day, looking for delirium risk factors, evidence of delirium and, if present, a diagnosis and management plan. Outcomes were reviewed at 90 days. Results Of 216 patients, 44% had evidence of delirium. 40% were missed, with only half of those diagnosed having a delirium-centred plan. Pareto analysis revealed 50% of >75-yr-olds on only four of twenty wards and 50% of delirium present on those same four wards. 90-day outcomes revealed: Subgroup analysis showed that, even when compared to other geriatrician led CGA based care, orthogeriatric patients with delirium had significantly higher rates of diagnosis (100% vs 53%), management (100% vs 35%), lower mortality (OR 0.55), comparable LOS, and fewer than half as many readmissions. Conclusions Delirium is concentrated on a small number of medical and orthopaedic wards. Orthogeriatric patients have significantly higher rates of diagnosis, delirium-focused plans, lower mortality and readmission rates. This data suggests that a best practice pathway, akin to that for hip fractures, mandating delirium screening for at-risk, especially frail, patients on high-risk medical wards may improve outcomes. This data has allowed us to develop a focused improvement plan based on a time-critical pathway.