• Gillian P Jackson, Catriona E Jackson, Jason W Boland, Imogen Featherstone, Chao Huang, Margaret Ogden, Kathryn Sartain, Najma Siddiqi, Maureen Twiddy, Mark Pearson, and Miriam J Johnson.
• Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
• Palliat Med. 2024 Apr 1; 38 (4): 447456447-456.

BackgroundDelirium is a complex condition, stressful for all involved. Although highly prevalent in palliative care settings, it remains underdiagnosed and associated with poor outcomes. Guideline-adherent delirium care may improve its detection, assessment and management.AimTo inform a future definitive study that tests whether an implementation strategy designed to improve guideline-adherent delirium care in palliative care settings improves patient outcomes (reduced proportion of in-patient days with delirium).DesignWith Patient Involvement members, we conducted a feasibility study to assess the acceptability of and engagement with the implementation strategy by hospice staff (intervention), and whether clinical record data collection of process (e.g. guideline-adherent delirium care) and clinical outcomes (evidence of delirium using a validated chart-based instrument;) pre- and 12-weeks post-implementation of the intervention would be possible.Setting/ParticipantsIn-patient admissions in three English hospices.ResultsBetween June 2021 and December 2022, clinical record data were extracted from 300 consecutive admissions. Despite data collection during COVID-19, target clinical record data collection (n = 300) was achieved. Approximately two-thirds of patients had a delirium episode during in-patient stay at both timepoints. A 6% absolute reduction in proportion of delirium days in those with a delirium episode was observed. Post-implementation improvements in guideline-adherent metrics include: clinical delirium diagnosis 15%-28%; delirium risk assessment 0%-16%; screening on admission 7%-35%.ConclusionsCollection of data on delirium outcomes and guideline-adherence from clinical records is feasible. The signal of patient benefit supports formal evaluation in a large-scale study.

9 keywords...

hide…