More patients will be diagnosed quicker and receive treatment when they arrive at hospital with delirium, as a new project expands in Greater Manchester.
Health Innovation Manchester, the organisation responsible for accelerating the discovery and implementation of innovation into the health and care system, is supporting deployment of the Early Detection for Delirium Project, which provides clinicians with a digital assessment tool to quickly identify those with delirium and ensure they receive the best care.
Delirium is a serious clinical condition, however it is often poorly recognised and under-diagnosed. It is recognised as a type of serious brain failure and symptoms include reduced awareness, a reduced ability to focus, disorientation and memory or language problems. It can cause distress to patients, family carers and also staff involved in their care.
It is a common condition and affects one in eight hospital inpatients, with people living with dementia particularly at risk. Delirium is associated with higher mortality rates, increased lengths of hospital stay, higher risk of readmission and increased risk of illness. However, it is treatable and around a third of cases are preventable.
The project, which will launch at Wythenshawe Hospital, part of Manchester University NHS Foundation Trust (MFT), and Royal Bolton Hospital, part of Bolton NHS Foundation Trust, will see all patients aged 65 or over or with a diagnosis of dementia screened for delirium on admission to hospital.
Clinical Lead for Delirium at the Royal Bolton Hospital, Dr. Gopalakrishnan Deivasikamani, said: “The aim is to treat delirium as a medical emergency and to do 4AT assessments as soon as possible for patients aged over 65. This will be done in close conjunction with the Emergency Department and training will be soon underway.
“This is an exciting opportunity to improve the assessment and management of delirium at the front door, but it does have its challenges. The frailty team will help with assessments and training and as with every development, we are taking one step at a time. Think Delirium – Call it a Delirium.”
Kate Gitsham, consultant geriatrician and dementia lead at Wythenshawe Hospital and clinical lead for the project at MFT, said: “MFT is committed to providing the best care to our patients, and those at risk of delirium which is why we are excited to be involved in this project with Health Innovation Manchester. Experiencing an episode of delirium can be very distressing for the patient, as well as those around them and by detecting delirium early we can ensure that patients receive timely treatment, care and support at our hospital.”
It follows the success of the Salford Global Digital Exemplar (GDE) delirium and dementia project which transformed the pathway for assessment and management of delirium using the early assessment tool.
Since the Salford project launched in 2017, the number of delirium cases identified has risen by 650 per year, an increase of 34%. Readmissions for delirium patients have reduced from 15% to 13% saving an estimated £184,000 in the first year.
The early detection project has been welcomed by Liz and Mike Brookes, from Rochdale, who have experienced first-hand the impact that a quick diagnosis of delirium can have on recovery.
Mike, who lives with vascular dementia, experienced an episode of delirium after rupturing his gall bladder. His wife Liz, a retired nurse, said: “I was telling people constantly that he was delirious, because it was clear to me that the mental state he was experiencing at that time was very different to how he is normally at home. But all people saw on the ward was his dementia.”
However, when Mike (77), a retired electronics officer in the Royal Air Force, experienced another episode of delirium while in Salford in September 2019, he was quickly diagnosed and treated thanks to the delirium early detection tool in use at Salford Royal.
Liz (64) continued: “No sooner than we arrived at Salford Royal’s A&E, the staff were on us. They looked at his age, his dementia diagnosis and the fact that he had experienced a previous episode of delirium and they assessed him for delirium.
“They took it all on board and he was diagnosed and treated straight away. I sat with him for four hours watching him improve dramatically.”
Mike spent four days in hospital before he was able to return home.
“The delirium didn’t progress, and he came home quickly and without any impact on his cognition,” Liz continued. “The assessment and quick treatment was excellent.”
In 2018/19 in Greater Manchester, there were more than 9,200 hospital admissions involving delirium within the over 65 population, making up 5.7% of total emergency admissions.
By implementing the digital assessment tool across more hospitals, the project aims to improve assessment of patients with delirium and ensure they commence treatment sooner, resulting in reduced mortality rates and reduced length of stay at hospital.
Early Detection for Delirium Project lead, Dr. Emma Vardy, consultant geriatrician and clinical dementia lead, Salford Royal NHS Foundation Trust, said: “Delirium is a serious clinical condition, but we can improve outcomes and reduce the amount of time patients spend in hospital if we identify and treat patients quicker.
“We have worked hard to develop and test the assessment tool and we are delighted to be able to share it with other organisations and enable them to use it to help improve care for more patients in Greater Manchester.”
Dr. Tracey Vell, clinical director of health innovation Manchester said: “The early detection tool for delirium is a fantastic example of an innovation developed within Greater Manchester which has the potential to improve care for patients and reduce the amount of time patients need to spend in hospital and maximising NHS time and resources.
“We are delighted to be working to accelerate the implementation of this assessment tool across more NHS Trusts in our area so more patients can benefit.”
