Aims: Delirium remains underrecognised and poorly documented in inpatient settings. Long-term sequelae may be reduced by appropriate discharge planning and follow-up. This study aimed to characterise documentation of post-discharge management plans for patients presenting with confusion in a GEM Unit, and to examine 28-day complications. Organisation-wide initiatives between 2016-2019 included rollout of delirium risk identification tool and online delirium training module for all staff.
Methods: Electronic medical records across two time points (2019 and 2024) were retrospectively reviewed for 100 consecutive admissions to a GEM unit at a major tertiary teaching hospital to identify presence of confusion. Data collected included demographics, diagnosis of confusion and/or delirium, post-discharge follow-up plans, and 28-day complications.
Results: In 2024, 24 of 100 admissions presented with confusion with 21 (87.5%) identified as delirium. Confusion or delirium was documented in 19 discharge summaries (19/24, 79.2%) with only 6 documenting confusion-specific follow-up plan (6/24, 25%). Within 28 days, 37.5% (n=9) of these patients were newly discharged to residential aged care facility (RACF), with documented follow-up in only 2 cases. Compared with 2019, the rate of delirium documentation as inpatient (29/57, 50.9%), on discharge summary (38/60, 63.3%), and follow-up plan (8/60, 13.3%) have improved. No significant association was observed between absence of a follow-up plan and 28-day readmission or mortality.
Conclusions: Post-discharge follow-up plans remain inadequately documented, despite improved identification of delirium, particularly among patients newly transitioning to RACF. Structured, consistent discharge planning may reduce complications. Ongoing staff education and engagement are beneficial in strengthening broader system-wide practice.