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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.
Data were collected in 2016.
- Executive summary (PDF)
- Full report (PDF)
- Crynodeb Gweithredol (PDF)
- Summary report for hospital managers and commissioners (PDF)
- Accessible version of the National Report (PDF)
- Hospital reports from 2017
Regional and 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)
We explored the feasibility of including community hospitals in the audit and the results can be found in this report (PDF).
Audit tools adapted for community hospitals:
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.