Delirium is a common, serious but often treatable condition that causes a person to become easily distracted and more confused than normal. It starts suddenly in someone who is unwell, and is more common in older people and people with dementia. The condition can be very distressing for the person and their family.
At Solihull Hospital the Delirium and Dementia Outreach Team (DDOT) believed that if returned to their own home, supported by skilled staff using an enabling model of care, delirium would quickly resolve. They created the Enhanced Recovery at Home pathway, working closely with Supported Integrated Discharge and Adult Social Care, and the results have been outstanding.
Photo caption: DDOT Lead Nurse Phil Hall (right) with Dr Anand Chitnis, Chair of Solihull Clinical Commissioning Group.
Lead Nurse Phil Hall explains that delirium is the most common ‘avoidable harm’ in hospitals, affecting up to 25 per cent of all patients. He says: "Often a patient is medically suitable for discharge but delirium causes them to remain extremely confused and is unsafe to return home. This often leads to new admission to residential care or failed discharge."
Phil looks back on the Enhanced Recovery at Home project as a huge success: “We discharged two or three patients at a time and by the end, only one patient had to be referred to 24-hour care. We hope to get the scheme recommissioned so we can continue to support people to return home, which is the better environment for them to recover from delirium.”
One patient was admitted to Solihull Hospital with a chest infection but was also very weak and confused. Caused by a combination of deliruim and as yet undiagnosed dementia, she was refusing to eat or drink, and was becoming more confused and frail. Her son said: “There did not seem any possibility that she would be able to go home in the near future, and the only option would have been to look for a nursing home. This would have proved stressful not only for my mother but for the whole family.”
Through the Enhanced Recovery at Home scheme, the patient was discharged home accompanied by a healthcare assistant. The patient’s son observed: “The improvement was almost immediate. My mother regained her appetite and has continued to make a remarkable improvement in her physical health. She is getting stronger and more mobile by the day.”
Patients receive 24-hour support on discharge, reducing gradually as appropriate until they can be left with a care package in place. This pathway is more cost-effective, reduces bed-blocking and is the preferred outcome for the patients and their families.
Phil reflected on winning the award: “The team is very dedicated and hard-working, and they have adjusted well to the new role and environment that the Enhanced Recovery at Home scheme brought. It’s always nice to have your efforts recognised and the win has helped to raise the profile of the project which hopefully will help in our campaign to have it recommissioned.”