Previous rounds of audit

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Information about the content of delirium screen and assessment

Overview

After analysing the data collected for Round 3, it became apparent that audit questions about delirium might be inconsistently interpreted, both within and between hospital sites. 

Hospitals were asked to submit data for a Spotlight audit focusing on the identification and assessment of delirium in order to look at variance in interpretation and to gain more accurate knowledge of the extent to which assessments are not performed.

Data collection

117 of 199 hospitals participated and were asked to complete 20 sets of casenotes per hospital which focussed on delirium screening and assessment.

Report

The full report is now available, this includes; key findings, recommendations, discussion of results, and a full breakdown of results from the national data set.

Key findings

A high proportion of patients with dementia admitted as emergencies to hospital did not receive an initial assessment for delirium, even after adjustment

After taking account of the greater number of initial assessments identified by the additional questions included in the questionnaire, we found that 32% of patients with dementia, admitted to hospital as an emergency, did not have an initial assessment or screen for delirium.

At just under one third of the sample, this remains a very high proportion of people at high risk of delirium and requires improvement. 

Questions about initial screen or assessment for delirium are inconsistently interpreted

Variation is apparent in the approach hospitals take to carrying out and recording the assessment of delirium, as questions about an initial screen or assessment for delirium are inconsistently interpreted. In 219 (10%) case notes, auditors reported no screen, but questions about specific assessments found that it had taken place. 

Following adjustment allowing for responses for the follow up questions, results for individual hospitals improved by an average of 19% with individual hospitals seeing increases ranging from to 64 percentage points.

Over a quarter of patients have no confusion or cognitive tests recorded

27% of patients received no confusion or cognitive tests at all, as well as no initial screen.  Cognitive assessment is an important part of comprehensive assessment which all patients with dementia admitted acutely should receive.

Delirium not included in discharge correspondence

Only 48% of patients whose casenotes recorded possible delirium at admission or after initial screening had this recorded on their discharge letter or summary. 

All patients who have delirium during admission to hospital should have this information communicated to their General Practitioner (and Primary Care team) on discharge.

We collected data in 2016 and reported in 2017.

Reports

Regional and Wales reports:

Feasibility study for community hospitals (2016)

Community hospitals showed an interest in being included. We explored this with a feasibility study of five community hospitals in 2015. The results can be found in this report (pdf).

In 2016, we ran a wider pilot of 20 hospitals and an event was held in December 2016 for pilot sites to give us feedback.

The pilot had four audit tools adapted for community hospitals:

Pilot phase for acute sites (2015)

What was the pilot for?

We developed new tools in the third round of NAD. During piloting, we gathered feedback from hospitals to make sure that any changes produced good quality data when used in the main audit. You can find more information on the pilot in our progress report (pdf), published in summer 2016.

Who was involved?

Ten acute sites were recruited from England and Wales. Hospitals were recruited based on their size and location, to make sure we had feedback from different types of organisations and areas.

Data collection ran from April to August 2010, with exception of the observation module which ran from January - April  2011.  The audit was divided into two parts: a 'core audit', and an 'enhanced audit'. 

Hospitals received local reports for the core audit in December 2010 and for the enhanced audit in March 2011. The national report was published in December 2011.

Reports

    Our online privacy notice gives you detailed information on when and why we collect personal information and how we use it.

    Carer and staff surveys are anonymous and case note audit submissions are pseudonymised (we do not ask for any identifying information such as name or NHS number), and allocated a number for the purposes of audit. For further details please refer to our data flow chart (xls). We have completed a Data Protection Impact Assessment (DPIA) (doc) to review our management of these data.

    Data collection is via an online audit tool using Formic’s Fusion Survey software. Formic abide by the stringent security requirements of the NHS for its systems and processes. Please see the following data security statement (PDF) on the Formic data collection software.

    We used HQIP’s UPCARE tool (doc) to collate information about the project governance and methodology into a single document.

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