Data collection for Round 4 has now closed and the reports will be published in 2019 (to view the Round 4 audit materials, please visit our Round 4 webpage).
Data tables for each round of the audit can be found on a separate page.
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Information about the content of delirium screen and assessment
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.
117 of 199 hospitals participated and were asked to complete 20 sets of casenotes per hospital which focussed on delirium screening and assessment.
- Sample copy of the tool. (doc)
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.
- Full report (pdf)
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.
View a list of all participating acute hospitals (pdf) in the third round of audit.
- Organisational checklist (pdf)
- Casenote audit (pdf)
- Staff questionnaire (pdf)
- Carer questionnaire (pdf)
- Standards for the third round of audit (pdf)
- Executive summary (pdf)
- Full report (pdf)
- Crynodeb Gweithredol (pdf)
- Summary report for hospital managers and commissioners (pdf)
- Accessible version of the National Report (pdf)
How did my hospital score?
Regional & Wales reports:
- North of England (pdf)
- Midlands and the East of England (pdf)
- South of England (pdf)
- London (pdf)
- Wales (pdf)
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:
- Carer questionnaire for community hospitals (pdf)
- Casenote audit (pdf) of people with dementia
- Organisational checklist (pdf) and analysis of routine data. Additional questions were also added to allow hospitals to comment on access to a range of specialist services.
- Staff questionnaire (pdf)
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 began in April 2012 and concluded in September 2012. Please view the terms and conditions (pdf) relating to data ownership and data sharing.
The audit had 2 modules:
210 hospitals (98% of eligible hospitals) across England and Wales, which included general acute hospitals or those providing general acute services on more than one ward, registered to participate in the audit.
When were the results published?
Hospitals who took part received their local report in February 2013. The national report was published in June 2013.
- National Report - full report (pdf)
- Executive Summary and Recommendations (pdf)
- Crynodeb Gweithredol ac Argymhellion (pdf)
- Easy Access Version - key findings and recommendations (pdf)
- Report for Wales - summary of key findings and data tables (pdf)
- Update on recommendations from the first round of audit (pdf)
The audit was divided into two parts: a 'core audit', and an 'enhanced audit'. 210 hospitals completed the core audit in the first round and 55 of these hospitals (145 wards) participated in the more in-depth enhanced audit.
What was involved in the core audit?
The core audit was open to all general acute hospitals, or those providing general acute services on more than one ward.
The core audit had two modules:
Data collection began in March 2010 and concluded in July 2010.
What was involved in the Enhanced audit?
The enhanced audit involved fewer general hospitals and had additional modules.
It evaluated the quality of person-centred care provided at ward level and the experiences of patients and carers. This helped us understand the perspectives of patients who may not be able to tell us directly about their experiences, for example because they have dementia, delirium or another condition which affects their memory or ability to communicate.
Each ward participating in the enhanced audit was asked to complete:
- Ward organisational audit (pdf)
- Ward Environmental Audit (pdf)
- Staff questionnaire (pdf)
- Carer/Patient questionnaire (pdf)
- Observation of care interactions:
- This module was a research program managed by Professor John Young (a consultant geriatrician) and Rosemary Woolley (a research fellow), based in the Academic Unit of Elderly Care and Rehabilitation, part of Bradford Teaching Hospitals NHS Foundation Trust and the University of Leeds. The unit has a record of more than 15 years of health services research using multi-method research designs.
Data collection began in April 2010 and finished in August 2010, with exception of the observation module that began in January 2011 and concluded in April 2011.
When were results published?
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.
Quality Improvement Workshops 2019
Throughout September and October 2019, we will be facilitating quality improvement workshops around England and Wales. The aim of these workshops is to develop practical applications to address hospital-specific shortfalls identified following the National Audit of Dementia Round 4 report. These workshops are open to audit leads, clinicians, QI and governance personnel and any other interested staff. Further details will be provided in due course.
e-bulletin: Sharing Practice to improve care for people with dementia
Illustrative case studies from the Round 3 action plans can be found in our e-bulletin (pdf).
If you have an article or idea which you'd like to share with us for a future bulletin, please contact us.