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Objectives Implementation research into delirium care is lacking. Exploiting known practice barriers to understand what management strategies work best in delirium is a means of prioritising care interventions. A consensus approach to determining priority interventions in delirium was derived and related to reference standards in health-care practice. Methods A workshop of 20 experts was held at the Australasian Delirium Association conference 2016. Structured small group work, iterative ranking and a 21-member check were undertaken to (i) explore research barriers in delirium care; (ii) explore how barriers related to individual items of multicomponent interventions; and (iii) rank multicomponent interventions in relation to each statement within the newly released Australian Commission on Safety and Quality in Health Care delirium standard. Results Top-ranking interventions included the following: education and training, comprehensive geriatric assessment, family partnerships, individualised care and multidisciplinary engagement. Conclusion Delirium experts identified a minimum standard of any care intervention for delirium.

Objective To evaluate the safety (mortality and readmissions) and efficiency (length of stay) of the hospital-in-the-home delirium pathway (THDP) compared with hospital-based care. Methods Patients admitted to THDP were compared against an age-matched cohort of patients with delirium managed entirely in hospital. Outcome data were obtained through retrospective chart review, and hospital coding was used to identify controls. Results Ninety-six patients were included in this study, of which 46 were managed on THDP. There was a significant frailty and co-morbidity burden with no differences in the demographic profile between groups. Inpatient length of stay was shorter on THDP (THDP mean 8 days, control 11 days; P = .02). One-month mortality was 13% in THDP compared with 24% in the control group (P = .2). One-month readmission was 30% in THDP and 18% in the control group (P = .23). Conclusion The hospital-in-the-home delirium pathway is a promising alternative to in-hospital delirium care for selected patients.

Delirium is a temporary condition involving a disturbance in attention, cognition and awareness. Typically, it develops over a relatively short time frame and fluctuates in severity. Delirium is preventable in one‐third of cases, and early detection improves outcomes 1. Yet, this common and potentially devastating hospital complication is associated with non‐detection rates as high as 70% 1, 2. Why is this?

Objective(s): A new model of care for the management of patients with delirium was developed and evaluated. Method: A 4-bedded Close Observation Unit (COU) was introduced. The model comprised an education strategy for assistants in nursing (AIN), environmental adaptations and AIN to patient ratio of 1:4. Outcomes in all patients with delirium before and after introduction of the new model of care were compared. Results: 105 patients were admitted to COU, of whom 100 (95%) were diagnosed with delirium. In-hospital mortality improved after introduction of the unit (15% versus 5%; p=0.002) without significant change in length of stay, discharge destination or falls frequency. Conclusion: A dedicated unit for delirium management within medicine achieved a reduction in mortality.