QI 1263 Improving the Delirium Pathway at an Acute Hospital: GEH AMHAT

Abstract

Aim: Reduce the percentage of referrals to AMHAT for delirium from 35% to <10% by 31st December 2023. AMHAT at CWPT provides liaison work to UHCW, SWFT and GEH and receives referrals from each of these areas. Delirium is a medical condition which needs to be treated medically by professionals at acute hospitals. Patients with delirium should not be referred to AMHAT. It was noted by the GEH AMHAT team that a relatively large number of referrals from GEH wards had delirium as an outcome. These inappropriate referrals delayed patient management as patients were waiting for a review by AMHAT when they could have received medical care on the ward. These cases also utilised AMHAT time that could have been directed to prioritise more appropriate referrals and tasks. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf; Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; Sustainability Tool - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-sustainability-model.pdf.

Project Impact: There was a reduction in the number of referrals identified as delirium from 44 (35%) in June, July and August to only 8 (6%) in October, November and December. Each inappropriate referral would take an AMHAT clinician an average of 1 hour, this equates to a potential saving of 36 hours of clinical time over October, November and December which could be utilised to reduce waiting times for other patients. Patients receiving the appropriate care on the ward rather than waiting for AMHAT review means their length of stay is reduced - a potential reduction of 72 bed days. Early management of patients as per the Delirium Pathway has increased leading to better patient experience. Right care at the right time and earlier discharges. Better prioritisation and use of clinician time for both Acute hospital staff and AMHAT.