Delirium

British Neuropsychiatry Association Teaching Weekend 2024

SLIDES


References

Guidelines & pathways

SIGN Guideline: Risk reduction and management of delirium. Scottish Intercollegiate Guidelines Network (SIGN), 2019.

Patient booklet on delirium. Healthcare Improvement Scotland / Scottish Intercollegiate Guidelines Network (SIGN), 2019.

Acute Hospital Care: Integrated Care Pathways and Delirium Algorithms. National Dementia Office (Ireland). 2020.

4AT, SQiD, NEWS2 & other relevant resources

Tieges Z, MacLullich AMJ, Anand A, Brookes C, Cassarino M, O'Connor M, Ryan D, Saller T, Arora RC, Chang Y, Agarwal K, Taffet G, Quinn T, Shenkin SD, Galvin R. Diagnostic accuracy of the 4AT for delirium detection: systematic review and meta-analysis. Age Ageing. 2020 Nov 11:afaa224.

Calf AH, Pouw MA, van Munster BC, Burgerhof JGM, de Rooij SE, Smidt N. Screening instruments for cognitive impairment in older patients in the Emergency Department: a systematic review and meta-analysis. Age Ageing. 2020 Oct 3:afaa183.

Chester JG, Beth Harrington M, Rudolph JL; VA Delirium Working Group. Serial administration of a modified Richmond Agitation and Sedation Scale for delirium screening. J Hosp Med. 2012; 7:450-3

Shenkin SD, Fox C, Godfrey M, Siddiqi N, Goodacre S, Young J, Anand A, Gray A, Hanley J, MacRaild A, Steven J, Black PL, Tieges Z, Boyd J, Stephen J, Weir CJ, MacLullich AMJ. Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the Confusion Assessment Method. BMC Med. 2019 Jul 24;17(1):138

Saller T, MacLullich AMJ, Schäfer ST, Crispin A, Neitzert R, Schüle C, von Dossow V, Hofmann-Kiefer KF. Screening for delirium after surgery: validation of the 4 A's test (4AT) in the post-anaesthesia care unit. Anaesthesia. 2019;74:1260-1266

Royal College of Physicians. National Early Warning Score (NEWS) 2. Standardising the assessment of acute illness severity in the NHS: additional implementation guidance. https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2

Sands MB, Dantoc BP, Hartshorn A, Ryan CJ, Lujic S. Single Question in Delirium (SQiD): testing its efficacy against psychiatrist interview, the Confusion Assessment Method and the Memorial Delirium Assessment Scale. Palliat Med. 2010 Sep;24(6):561-5.

Voyer P, Champoux N, Desrosiers J, Landreville P, McCusker J, Monette J, Savoie M, Richard S, Carmichael PH. Recognizing acute delirium as part of your routine [RADAR]: a validation study. BMC Nurs. 2015 Apr 1;14:19.

QI / implementation

Angel C, Brooks K, Fourie J. Standardizing Management of Adults with Delirium Hospitalized on Medical-Surgical Units. Perm J. 2016 Fall;20(4):16-002.

Baird L, Spiller JA. A quality improvement approach to cognitive assessment on hospice admission: could we use the 4AT or Short CAM? BMJ Open Qual. 2017; 6(2):e000153

Bauernfreund Y, Butler M, Ragavan S, Sampson EL. TIME to think about delirium: improving detection and management on the acute medical unit. BMJ Open Qual. 2018 Aug 13;7(3):e000200

Brown EG, Josephson SA, Anderson N, Reid M, Lee M, Douglas VC. Evaluation of a multicomponent pathway to address inpatient delirium on a neurosciences ward. BMC Health Serv Res. 2018 Feb 12;18(1):106.

Friedman JI, Li L, Kirpalani S, Zhong X, Freeman R, Cheng YT, Alfonso FL, McAlpine G, Vakil A, Macon B, Francaviglia P, Cassara M, LoPachin V, Reina K, Davis K, Reich D, Craven CK, Mazumdar M, Siu AL. A Multi-Phase Quality Improvement Initiative for the Treatment of Active Delirium in Older Persons. J Am Geriatr Soc. 2020 Nov 4.

Lee SY, Fisher J, Wand APF, Milisen K, Detroyer E, Sockalingam S, Agar M, Hosie A, Teodorczuk A. Developing delirium best practice: a systematic review of education interventions for healthcare professionals working in inpatient settings. Eur Geriatr Med. 2020 Feb;11(1):1-32.

National Hip Fracture Database (NHFD)(England). Annual Report 2018.

O'Shaughnessy Í, Romero-Ortuno R, Edge L, Dillon A, Flynn S, Briggs R, Shields D, McMahon G, Hennessy A, Kennedy U, Staunton P, McNamara R, Timmons S, Horgan F, Cunningham C. Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department. Eur J Intern Med. 2020 Nov 23:S0953-6205(20)30425-8.

Reynish EL, Hapca SM, De Souza N, Cvoro V, Donnan PT, Guthrie B. Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions. BMC Med. 2017 Jul 27;15(1):140.

Rohatgi N, Weng Y, Bentley J, Lansberg MG, Shepard J, Mazur D, Ahuja N, Hopkins J. Initiative for Prevention and Early Identification of Delirium in Medical-Surgical Units: Lessons Learned in the Past Five Years. Am J Med. 2019 Dec;132(12):1421-1430.e8.

Vardy ERLC, Thompson RE. Quality improvement and delirium. Eur Geriatr Med. 2020 Feb;11(1):33-43.

Other resources

Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, Slooter AJC, Ely EW. Delirium. Nat Rev Dis Primers. 2020 Nov 12;6(1):90.