By Dr Sharmella Summan
The doctors and nurses saved my life. The porter soothed my despairing soul. My family, despite my resistance, loved my heart back together.

What are your tool completion rates? What level of delirium are the tools detecting, and do they reflect the real rates of delirium? Only by closely measuring what we are doing can we tell if our hospitals are truly delirium-sensitive.

[1] Delirium can be a presenting feature of life-threatening illness, physiological disturbance or drug intoxication

People with delirium often have serious, acute illness. In some cases the delirium is the presenting feature, with perhaps only a few other clues.

Something that I had initially found confusing in the field of delirium was the sheer number of tools that have been developed. A huge variety. And it was not always clear what each one was for and how it should be used.

You approach a patient’s bedside with the aim of doing an assessment for delirium. The first thing you notice is that the patient is very sleepy, and they do not respond verbally to your greeting and a touch on their shoulder. They open their eyes for a few seconds, but they show no other response. They do not produce any speech.

We all know that healthcare systems could do better in detecting delirium - this remains a major priority. But we know from studies that even in patients with a diagnosis that families are often left in the dark.Many families do not know what delirium is and how to recognise it. So when sitting with their family member with delirium they may think that the person has developed dementia …

Guidance to practitioners based on validation data alone is incomplete: a tool performing well under research conditions may not perform well under clinical conditions. At the moment we are mostly operating in the dark, not really knowing if policy advice based on data from research validation data alone is good.