Improving Recognition of Delirium in Elderly Patients Hospitalized for Hip Fracture

Background: Delirium is a frequent, yet often under recognized, condition affecting elderly patients hospitalized with hip fracture. In the literature, delirium rates vary for this population. Objective: This project aimed to determine the delirium rate in elderly patients hospitalized for femur fracture and improve recognition through use of a screening tool at an academic medical center. Methods: The pre-intervention delirium rate in elderly hip fracture patients was determined via retrospective chart review with a validated instrument for patients hospitalized during a 3-month window. To improve delirium recognition, nurses completed training covering delirium and using the Confusion Assessment Method (CAM), a validated delirium screening tool. Presentation effectiveness was measured with pre/post surveys. Elderly hip fracture patients were screened using the CAM. Following implementation, nurses were surveyed regarding using the CAM. Retrospective chart review determined frequency and accuracy of CAM use. Results: Pre-implementation retrospective chart review demonstrated 45% (n=14) of elderly hip fracture patients developed delirium. Education increased reported comfort with delirium, its risk factors, and use of the CAM. During implementation, the CAM was used in 75% (n=9) of qualifying cases and rate of delirium was 25% (n=3). All cases were in patients with baseline cognitive impairment. Screening barriers included EHR and workflow difficulties. Conclusions: This institution’s delirium rate for this population aligns with the literature and serves as a benchmark for efforts to target and reduce delirium incidence in a measurable way. Dissemination of delirium education improved delirium competence, reduced its frequency, and improved recognition of the disorder