Incidence rates and multidisciplinary response to delirium in acute stroke: a mixed methods investigation
Delirium is a serious medical condition affecting up to 30% of hospital in-patients and associated with significant negative consequences such as increased mortality, morbidity as well as an increased long term risk of cognitive impairment. Delirium is difficult to identify due to its fluctuating course and the various subtypes, which are not well recognised by hospital staff. Stroke patients display a number of the precipitating and predisposing factors for delirium, yet the incidence of delirium in this population is not well documented. It is not known how best to identify delirium in this population and the ways in which multidisciplinary healthcare staff understand the condition. This thesis outlines the mixed methods of investigation which set out to answer these questions, utilising a systematic review and meta-analysis, an online survey, and online focus groups. The thesis makes a novel contribution to the field of stroke research in identifying the incidence of delirium as 28.1% (95% CI: 22.9 to 33.2), as well as synthesising research on the specific risk factors and outcomes associated with delirium in this population. The thesis also highlights the inconsistent practice of delirium identification in acute stroke, in both research and clinical practice. A further contribution is in the response of various healthcare professionals when it comes to identifying delirium in stroke patients: more doctors than nurses identify delirium, nurses have a recognised role in highlighting physiological changes associated with the condition and allied health professionals may lack confidence in their knowledge of the condition, as seen in their use of tentative language to discuss delirium. Despite this, the data suggest that the appropriate management of the condition takes place. The thesis argues that more education and organisational recognition of delirium as a diagnostic priority needs to take place in order to potentially improve outcomes for this population.