1. TRYING TO PLACE DELIRIUM ON THE HEALTH CARE AGENDA OF THE 21ST CENTURY
Jessica PÉREZ**, David SIMON*; Ignacio GÓMEZ-REINO  *; Elisabeth BALSEIRO**, Cristina CARCAVILLA**
Psychiatrist*. Psychiatry Resident (MIR)**. Psychiatric Service. Complexo Hospitalario de Ourense.
Filiación / Hospital
AIMS
Describe the activity of the Consultation and Liaison Psychiatry Program in our hospital (Public University General Hospital, 854 general beds, in province of Ourense) during one year focusing on delirium cases since our area has one of the oldest European populations nowadays and will probably increased in next years ( people in 2016).
To review and adapt information and educational material for personal, families and patients about delirium.
Ensuring appropriate service development based on the deficiencies in current practice to better quality management of patients. 1
MATERIAL AND METHOD
A retrospective observational study was carried out including all psychiatric consultations from Ourense Universitary Hospital between January 1st - December 31st, 2014.
- Descriptive Statistic Chi Square was used for cuantitative analysis.
- After consultation, some clinical and sociodemographic data were collected and saved in a computerized registry.
We also reviewed educational material and campaigns/interventions to prevent delirium (using Medline, PubMed, and references from relevant original articles).
No conflicts of interest reported by authors.
Table 4
Table 1
Table 2
Table 3
Family information brochure proposal-Photo 1
RESULTS
576 consultations were performed (Table 1). The Confusional State (24,0%) and Adjustment Disorder (22,0%) were the most prevalent psychiatric diagnoses (Table 2 and 3). Significant associations emerged between medical and surgical wards in relation with reason for referrals, priority and the final diagnosis (P< 0,001).
Comparing the final diagnosis results in our hospital with the hospital of Melbourne and with other Spanish hospitals participating in the ECLW, we found some differences. In Ourense, the most frequent diagnosis is the confusional state (24%), which added to diagnoses of dementia (5.2%) (Table 4), set up the group of organic mental disorders, that are less frequently diagnosed in Melbourne (21%), as in other Spanish hospitals (18.1%).
The most frequent diagnosis in our hospital is the Organic Mental Disorder ( Confusional State).
There are no educational kits, brochures or intervention programs with families in our hospital neither in Spanish hospitals. Although, there are novel initiatives in ICUs ( HU-CI Project).
CONCLUSIONS
We need to increase and widespread education for clinicians about the importance of delirium, the most prevalent diagnosis in patients attended in our C-L Psychiatry Unit .
Because of continuous increase of ageing population in our area, it is expected that delirium cases will also have an increase.
We need to develop the role of humanization of delirium care, specifically family engagement, empowerment and other non-pharmacological interventions in order to achieve patient and family long-term outcomes. (Toye, 2014; Cochrane Reviews 2016) as some ICU have introduced and powered durimg last years.
We have decided to adapt and introduce in our hospital educational leaflets and guides for patients, families and professionals in general hospital units to improve service delivery. We have reviewed some of educational material from Hospital Elder Life Program HELP (Inouye, 2017; Royal College Psychiatry, Tees, Esk and Wear Valleys NHS, American Delirium Society, American Geriatric Society, European Delirium Association, Scotish Delirium Association, NHS for Scotland, Health ans Social Care in Northern Ireland, ICu Delirium Vanderbilt University, Canadian Institutes of Health Research R.A.D.A.R., UHN Toronto General Hospital. We have designed a first delirium brochure proposal and our intention is to make a interdisciplinar consensus with nurses and other medical and surgery services about this brochure delirium project (Photo 1).
We need to place Delirium on the Health Care Agenda as many authors propose (Shaughnessyn, 2012; Inouye, 2104) involving all health workers, scientific societies, and also familiar and persons affected in a macro-strategy similar to that “Think delirium” strategy in the British and Scottish NHS, and that does not exist in Galicia nor in Spain.
The establishment of a specific program of early detection may be an objective to be developed in the medium term, in this way, it would be possible to generate liaison programs in other areas where the participation of the psychiatrist is more specific . It could be analyzed how this percentage evolves in the next years once established programs indicated.