Quality project to prevent delirium after hip fracture

Objectives: It has been demonstrated that a series of strategies supervised by a geriatrician can reduce the incidence of delirium in elderly hip fracture patients. The aims of this project were to determine if a geriatric registrar could introduce these strategies and alter the incidence of delirium in our orthopaedic unit.Methods: The program used quality improvement methods and included staff education and the use of a checklist to facilitate the use of the strategies. We counted the number of recommendations made, the subsequent adherence to the recommendations and the before and after monthly incidence of delirium.Results: The geriatric registrars made 424 recommendations (average six per patient) during a 3-month intervention period, of which 89.9% were adhered to. Baseline data indicated an incidence of delirium of 10/28 cases (35.7%). Following introduction of the strategies, subsequent monthly incidences of delirium were 4/28 cases (14.3%), 3/22 cases (13.6%) and 2/21 cases (9.5%) (P <0.035 compared with baseline).Conclusions: We conclude from this short program that methods proven to prevent delirium can be introduced into routine clinical practice and that this appears to prevent cases of delirium.