Screening for delirium in specialist palliative care inpatient units: perceptions and outcomes.
OBJECTIVE
The UK National Institute for Health and Care Excellence (NICE) indicate that palliative care patients are at high risk of delirium and should be screened for it using the short confusion assessment method (short CAM). This study aimed to assess the perceptions of the short CAM for delirium screening amongst health-care workers in specialist palliative care inpatient units (SPCUs) and to investigate its use as a screening instrument.


METHODS
Patients in 5 SPCUs in the North East of England were screened for delirium using the short CAM and a staff survey assessed the acceptability of the short-CAM in this setting.


RESULTS
Of the 63 staff surveyed, 79.4% felt screening for delirium was important and 59.3% found the short CAM 'not at all' burdensome to complete. However, only 40.7% felt that the short-CAM often accurately reflected patients' conditions and none felt it always accurately reflected patients' condition. Of 298 patients screened, 20% screened positive on the short CAM. Malignant and intra-cerebral diseases were significant independent predictors of a positive screen. Hospice length of stay and in-hospice mortality were higher in those with a positive result (66.7%) than in those without (38.2%).


CONCLUSIONS
Health professionals deem delirium screening to be important in SPCUs, but may not support routine use of the short CAM. This could reflect a limited perceived impact on care and lack of confidence in this tool to reflect a complex patient group.
Consultant in Palliative Medicine, South Tyneside NHS Foundation Trust, England, UK.
Anna
A
Porteous
Specialist Trainee in Palliative Medicine, Health Education North East, England, UK.
Felicity
F
Dewhurst
Statistician, Northumbria Healthcare NHS Foundation Trust, England, UK.
William Keith
WK
Gray
Specialist Trainee in Palliative Medicine, Health Education North East, England, UK.
Paul
P
Coulter
Specialist Trainee in Palliative Medicine, Health Education North East, England, UK.
Ulka
U
Karandikar
Specialist Trainee in Palliative Medicine, Health Education North East, England, UK.
Rachel
R
Kiltie
Consultant in Palliative Medicine, North Tees and Hartlepool NHS Foundation Trust, England, UK.
Lucy
L
Lowery
Specialist Trainee in Palliative Medicine, Health Education North East, England, UK.
Fiona
F
MacCormick
Consultant in Palliative Medicine, South Tyneside NHS Foundation Trust, England, UK.
Ann
A
Paxton
Specialist Trainee in Palliative Medicine, Health Education North East, England, UK.
Jonathan
J
Pickard
Specialist Trainee in Palliative Medicine, Health Education North East, England, UK.
Grace
G
Rowley
Specialist Trainee in Palliative Medicine, Health Education North East, England, UK.
Jennifer
J
Vidrine
Consultant in Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, England, UK.
Rowan
R
Walmsley
Specialist Trainee in Palliative Medicine, Health Education North East, England, UK.
Kerry
K
Waterfield
Specialist Trainee in Palliative Medicine, Health Education North East, England, UK.
Donna
D
Weiand
Consultant in Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, England, UK.
Eleanor
E
Grogan
D001291:Attitude of Health Personnel; D003693:Delirium / Q000175:diagnosis*; D004739:England; D005260:Female; D006757:Hospital Units; D006801:Humans; D007902:Length of Stay; D008297:Male; D010166:Palliative Care
Confusion; Delirium; Delirium screening; Short CAM