Shifting the focus: A QI project to improve the management of delirium in patients with hip fracture.

Introduction: Delirium is common in the perioperative setting, particularly in those admitted with a neck of femur fracture. It is associated with poorer outcomes, including increasing mortality, morbidity and prolonged hospital stay. It is often poorly recognised and under diagnosed.

Setting: An urban district general hospital.

Intervention: A steering group was set up and used 'plan, do, study, act' methodology to develop a diagnostic pathway and educational programme for all staff working with patients admitted with neck of femur fracture.

Results: There was an increase in the multidisciplinary teams use of the 4AT delirium screening tool by 26% (p=0.0008). Staff surveys indicated an increase in the knowledge of delirium and confidence at explaining it to patients.

Discussion: By increasing staff confidence and use of recognised screening tools it is hoped that accurate diagnosis of this perioperative complication is improved, leading to improved management of these complex patients.