Delirium is one of the commonest and most serious syndromes encountered in acute care, yet recognition and management remain highly variable across services. This clinically focused talk will review practical approaches to delirium assessment and management at the front door, including the interaction between frailty, dementia, acute illness, and arousal. We will discuss how improving expertise in delirium can help clinicians identify unmet need earlier, improve patient and family experience, and drive wider service improvements across acute and community pathways.