Introduction Delirium is associated with increased mortality and length of stay, and early recognition can impact management of delirium during an acute admission. This project supports the Trust Quality Priority and national priority (in accordance with Getting it Right First Time) to establish a frailty pathway by improving identification of cognitively frail patients.

Aims and objectives of the research project or activity We aimed to increase rates of delirium screening using the 4AT tool in the Emergency Assessment Unit (EAU). We looked more closely at the different factors leading to decreased rates of screening in this area and how to create sustainable change.

Method or approach We undertook a system flow map to look more closely at the personnel and the department structure, and used this to identify where best to focus our efforts when gaining insight into the issues surrounding delirium screening

We think completed stakeholder analysis to ensure we made contact with the appropriate people followed by a fishbone diagram to analysis potential factors leading to decreased rates. We identified people factors as an area to look at; we then created a staff survey and undertook staff interviews in the Emergency Assessment unit to gauge understanding and opinions. These viewpoints were then fed back to the sponsors and senior stakeholders at regular working group meetings.

We created a list of change ideas, including easily achievable high impact ideas such as education, and have contacted educational leads to arrange teaching sessions. We have also been asked to update the delirium posters within the trust to reflect the new guidance for screening- these will be for re-distribution shortly.

A sustainability model has helped us guide our stakeholders on where their focus should be if they want to make the most impactful change to this project aiming to improve rates of delirium screening.

Findings Our survey identified 81% of respondents didn’t know where to find the 4AT tool on EPR and 56% didn’t know how to do the test. Our staff interviews revealed that staff also were not sure of the benefits to the patients or their work in doing delirium screening.

We have identified education about delirium and delirium screening is key to improvement and we are planning to deliver this with ongoing teaching and visual aids such as posters and flashcards which are in process. Digital changes on Electronic Patient Record are also due to come into effect which will change the way that delirium is recorded.

Our sustainability model has identified the biggest opportunity for sustained change is to focus on the benefit of improved screening to patients, staff and the organization with things such as the frailty pathway and delirium care bundle and have been discussing this with sponsors.

We are handing over this project to the Trust Cognitive Frailty Working Group for future development and are providing some of the teaching beyond the timescale of the Leadership programme in which we were undertaking this project

Key messages

1. Delirium is associated with increased mortality and length of stay

2. We are aiming to increase the rates of delirium screening in EAU through education, visual aids, and digital changes on the computer based screening tool

3. Focusing on what benefits patients, staff and the organisation will provide the biggest impact on improving these rates of screening