The Easily Missed Key to Safe and Efficient Care

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Delirium is often missed in hospitals,  severely impacting a patient’s recovery or causing them further ill health. To combat this the Australian Commission on Safety and Quality in Health Care (ACSQHC) has developed a new clinical standard.

The new Delirium Clinical Care Standard aims to ensure patients who arrive at hospital with delirium receive the best possible treatment, according to Commission Board Chair, Professor Villis Marshall.

“Delirium is an acute change in mental status that can be a frightening and isolating experience for patients and distressing for their loved ones and carers – it disturbs consciousness and interferes with the ability to communicate, focus attention and think clearly – making it an important safety and quality issue for all Australian hospitals.

“It is important to distinguish delirium from other conditions like dementia and to investigate it properly, because it can be the only sign of an acute, underlying, serious illness,” he said.

The ACSQHC defines delirium as “a disturbance of consciousness, attention, cognition and perception that develops over a short period of time”.  It can occur at any age but older people and patients with a history of dementia are at greater risk.

The age-group most at risk, patients aged 65 plus, account for more than one in three private hospital separations.

Delirium increases the likelihood of many adverse outcomes for patients, Commission’s Delirium Clinical Care Standard Topic Working Group Chair, Associate Professor Gideon Caplan said.

“Compared with other older patients in hospital, those with delirium have poorer outcomes, including increased mortality, more adverse events such as falls, infections and pressure injuries, an accelerated rate of cognitive and functional decline, longer hospital stays, more unplanned re-admissions and increased early entry to residential aged care facilities – making it a critical issue affecting thousands of Australians.

“The Delirium Clinical Care Standard is an important national approach to providing high quality care for people with, or at risk of, delirium.”

ACSQHC research shows 10% of Australians aged over 70 years have delirium at the time of admission to hospital and a further 8% develop delirium during a hospital admission. Incidence climbs steeply for patients admitted to intensive care regardless of patient age.

As many as 30% of patients under-going hip and cardiac surgery are likely to experience delirium.  This indicates the impact for the private hospital sector which provides around half of all cardiac surgery and almost 60% of all orthopaedic surgery.

ACSQHC recommends cognitive screening on admission to identify those at risk.  Criteria include:

  • Aged over 65 years
  • Known cognitive impairment/dementia
  • Severe medical illness
  • Hip fracture

There is also an ongoing campaign to increase awareness of cognitive impairment. Organisations can sign up to support ACSQHC’s #Betterwaytocare campaign at: http://cognitivecare.gov.au/

The Delirium Clinical Care Standard can be down loaded from the ACSQHC website together with a range of fact sheets and handbooks for clinicians and consumers.

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