Abstract
The EDITH (Emergency Department in the Home) service provides an alternative to Emergency Department attendance for the older adult by providing emergency care in the person’s home. This includes both medical and occupational therapy assessment with a focus on admission avoidance, implementing alternative care pathways and supporting patients to live at home.
Currently there is an inpatient Delirium Pathway for the acute hospital setting, however there is no counterpart for the pre hospital setting. Therefore, a decision was made to develop a specific pathway for the EDITH service; a Delirium Pathway for pre hospital care. The Delirium Pathway was developed following a focus group within the OT team. Key areas for assessment and consideration were identified. National and international guidelines regarding delirium management were reviewed and informed the development of the Delirium Pathway. Due to the unique nature of the pre hospital service, it was imperative that the pathway consisted of both medical and non-medical interventions of delirium such as; home environment optimisation, family/care giver education including therapeutic use of activity and functional engagement.
The Delirium Pathway is based on current research and both national and internal guidelines such as Dementia and Delirium guidelines (NICE 2010, SIGN 2018.) The Delirium Pathway was benchmarked against similar pathways within acute and community settings, and subsequently adapted to suit the needs of the EDITH patient cohort and home environment. Clinical guidance was sought from emergency department consultant with interest in geriatric medicine. Input was also gained from stakeholders such as advanced nurse practitioner, registrars and OT colleagues. Trial use of the pathway was completed over a two month period. Feedback was sought from stakeholders and necessary amendments to the Delirium Pathway were made. The pathway was then officially rolled out alongside education sessions on the utilisation of same.
This project has resulted in the development of a bespoke Delirium Pathway for pre hospital care which provides guidance and support to clinicians and family. Utilisation of the Delirium Pathway has enabled patients with a delirium to be managed within the home environment. This is a move towards alternative care pathways as traditionally these patients would have warranted a hospital admission. Key areas captured within the pathway include; assessment for delirium, use of 4AT screening tool, investigations for cause, management plan incorporating both pharmacological and non-pharmacological management, follow up and onward referrals. A planned audit will provide an opportunity to explore improved perceived outcomes for patients and their families experiencing delirium by supporting them to safely manage delirium in the home environment.
The development and implementation of the Delirium Pathway encourages better long term outcomes if the delirious patient is safe to be managed at home. Thus, in line with the ethos of the EDITH service, shifting the assessment and management from the hospital to home environment.