Identifying and treating underlying causes

Quality statement 5

A patient with delirium is offered a set of interventions to treat the causes of delirium, based on a comprehensive assessment that includes relevant multidisciplinary consultation.

Purpose

To ensure patients with delirium receive timely and appropriate treatment for the underlying cause(s) of delirium.

What the quality statement means

For patients

If you are diagnosed with delirium, a clinician will carry out a medical check to identify what is causing the delirium and how best to treat it. You and your family or carer will be consulted as part of the assessment. This may include a physical examination, tests (such as blood or urine tests, chest X-ray), a check of the medicines you are taking and any recent changes to them, and checking whether you are in pain. You will receive treatments for anything that may be causing your delirium. For example, your medicines may be changed, you may be given more fluids or you may be given antibiotics if you have an infection.

For clinicians

Carry out a comprehensive assessment of the patient, in consultation with the patient and their family or carer, to identify possible causes of delirium. Seek a patient summary from the patient’s general practitioner to help inform the investigation.

A comprehensive assessment involves:

  • A medical and social history, paying close attention to the patient’s medication history, including adverse reactions, their pain management needs, and their hydration and nutritional status
  • A physical examination
  • Investigations, informed by the medical history and physical examination
  • Consultation with other clinicians with relevant expertise (such as a geriatrician, psychiatrist, dietitian), whenever possible. In rural and remote health services this could be facilitated by using telehealth when information technology systems allow.

Start treatment based on the cause when it can be identified. Ensure that the multicomponent interventions recommended for preventing delirium are also in place to manage delirium, including involving family or carers and modifying the environment (see Quality statement 2). Prevention is the most effective strategy, but outcomes for patients with delirium can also be improved by early intervention. Monitor patients regularly for changes in cognition and behaviour, including clinical deterioration.

For health service organisations

Ensure that systems and processes are in place to support clinicians in identifying and treating the causes of delirium. Ensure that arrangements support multidisciplinary assessment, including telehealth consultation with clinicians, such as dietitian, nurse practitioner, geriatric medicine or psychiatry consultants when required.

Within a local health region, consider the hub-and-spoke organisation design model to support the provision of multidisciplinary assessment to rural and remote health services. The relationship between the larger hospital (hub) and the rural facility (spoke) could be structured to suit local arrangements, using information and communication technologies.

Provide regular training for staff on strategies to prevent and treat delirium.

For patients

If you are diagnosed with delirium, a clinician will carry out a medical check to identify what is causing the delirium and how best to treat it. You and your family or carer will be consulted as part of the assessment. This may include a physical examination, tests (such as blood or urine tests, chest X-ray), a check of the medicines you are taking and any recent changes to them, and checking whether you are in pain. You will receive treatments for anything that may be causing your delirium. For example, your medicines may be changed, you may be given more fluids or you may be given antibiotics if you have an infection.

For clinicians

Carry out a comprehensive assessment of the patient, in consultation with the patient and their family or carer, to identify possible causes of delirium. Seek a patient summary from the patient’s general practitioner to help inform the investigation.

A comprehensive assessment involves:

  • A medical and social history, paying close attention to the patient’s medication history, including adverse reactions, their pain management needs, and their hydration and nutritional status
  • A physical examination
  • Investigations, informed by the medical history and physical examination
  • Consultation with other clinicians with relevant expertise (such as a geriatrician, psychiatrist, dietitian), whenever possible. In rural and remote health services this could be facilitated by using telehealth when information technology systems allow.

Start treatment based on the cause when it can be identified. Ensure that the multicomponent interventions recommended for preventing delirium are also in place to manage delirium, including involving family or carers and modifying the environment (see Quality statement 2). Prevention is the most effective strategy, but outcomes for patients with delirium can also be improved by early intervention. Monitor patients regularly for changes in cognition and behaviour, including clinical deterioration.

For health service organisations

Ensure that systems and processes are in place to support clinicians in identifying and treating the causes of delirium. Ensure that arrangements support multidisciplinary assessment, including telehealth consultation with clinicians, such as dietitian, nurse practitioner, geriatric medicine or psychiatry consultants when required.

Within a local health region, consider the hub-and-spoke organisation design model to support the provision of multidisciplinary assessment to rural and remote health services. The relationship between the larger hospital (hub) and the rural facility (spoke) could be structured to suit local arrangements, using information and communication technologies.

Provide regular training for staff on strategies to prevent and treat delirium.

Read Quality statement 6 - Preventing complications of care