Latest news with #delirium
The Independent
3 days ago
- Health
- The Independent
Lucy Letby's hospital slammed for A&E failings over ‘unsafe' corridor care that left elderly patients delirious
Lucy Letby's hospital trust has been slammed for a string of emergency care failings, including unsafe corridor care that led to elderly patients developing delirium. The Countess of Chester Hosptial, where Lucy Letby worked and was convicted of murdering seven babies and attempting to murder seven others, was criticised by the Care Quality Commission (CQC) over delays in the care of sepsis patients, as well as elderly patients who were left for so long that they developed 'corridor-induced delirium'. The hospital was also criticised for having 'visibly dirty equipment' and out-of-date medical devices, including some with damaged wires hanging out. The watchdog has handed the trust a formal warning notice over the failures identified after the CQC's inspection in February 2025. Concerns included: Mental health patients being left with staff who were sleeping or on their phones Patients with fractured hips are forced to sit in wheelchairs when they should have had beds Inspectors found 59 incidents of delays to providing sepsis treatment, 44 of which were because the trust failed to take patients from ambulances quickly enough Evidence that 'long stays on the corridor' and the deterioration of patients because of this was 'normalised' The watchdog described the department as 'gridlocked', with patients telling inspectors it was 'as busy as a nearby motorway'. It said: 'Patients were frequently treated in unsuitable and unsafe areas, including corridors, with little privacy.' 'Patients were left on trolleys or in chairs for extended periods, leading to deconditioning and unmet basic needs,' it added. The report found some staff were 'task-focused and lacked compassion'. It also warned about cultural issues within the A&E department and found that some staff did not always feel they could raise concerns or that concerns would be acted on if they did so. In one incident, the CQC's inspectors had to inform the trust's chief executive after they saw a staff member speaking 'discourteously' in front of patients. The comment was described as 'serious and inappropriate'. It also highlighted concerns over the trust's use of an external company to provide staff to monitor mental health patients in A&E, after inspectors found patients were left unattended. Inspectors said: 'We observed a staff member employed by this service using their mobile phone and placing themselves away from the patient behind a door where constant observations could not be maintained for a period of 15 minutes. 'Incident data also showed an incident where ED staff had found the third-party provider staff asleep whilst on continuous observations.' Overall, the report said: 'The service's culture did not ensure staff consistently modelled positive or professional behaviours, with instances of inappropriate behaviour not in line with the trust's vision and strategy.' It stated that the department's leaders 'lacked clarity and consistent visibility' and warned that 'governance and accountability were weak, with repeated failures to address known risks'. 'Staff experiences with raising concerns were mixed.'
Forbes
5 days ago
- Health
- Forbes
Hospitals Must Better Identify And Manage Delirium In Seniors
I recently visited a friend who is in his 80s and was hospitalized after a fall. He did not know where he was, was convinced lawyers had come to visit him in the night (a truly horrifying thought), and was extremely agitated. While it still is not clear what happened, he may have been experiencing delirium, which happens to as many as one-third of older adults during a hospital stay. Patients and their families need to be aware of this condition, and hospitals need to do more to prevent it. A Common Problem Delirium occurs frequently in intensive care units and often after surgery. But even patients in medicine units, such as my friend, can be victims. It is not dementia, but often older patients with this confusion are written off as if it is, which is to say not treated at all. As many as three in ten older patients may acquire delirium in the hospital. And the consequences can be severe, including longer hospital stays, more readmissions, frequent discharges to institutional care instead of home, increased likelihood of true dementia, and even death. The financial cost: As much as $182 billion annually in the US. There are as many as 40 different screening tests for hospital-acquired delirium, but relatively little research on which are best. More troubling, while screening is common in ICUs, where it may be done daily, it is less frequently used for visitors to emergency departments or for patients in medicine units. Multiple Causes Some good news: Two recent articles in the journal JAMA Internal Medicine highlight positive results from a pair of simple delirium screening tests in Oxfordshire, England. While they leave open some unanswered questions, they highlight an easy first step towards addressing delirium—identifying it. Delirium is complicated because it seems to have multiple causes, some associated with hospital stays but also linked to pre-existing conditions. They may include dehydration and malnutrition, which are dangerously common among older adults. They may also be linked to the hospital environment itself, such as being in bed for long periods of time, disrupted sleep cycles, and use of multiple medications. In ICUs, constant alarms, being on a ventilator, being improperly sedated, and even the absence of natural light can lead to delirium. Often, these issues can feed off one another. For example, delirium may affect patients' ability to follow instructions or their anxiety may make them want to get out of bed when they should not. Bed alarms may add to their confusion, or staff may sedate them, which can worsen their delirium. Increases in ED boarding times, where older patients may spend hours or even days on gurneys in hallways while they wait for an available room, may make the delirium problem even worse. However, delirium may be preventable in up to 40 percent of cases. And hospitals can address it. But they first must identify it. The English Experience That's where the English experience may help. Since 2015, the National Health System in Oxfordshire has built delirium screening into the electronic health record for every patient over age 70 who visits an ED. After administering the simple 10-question test, a doctor determines whether the patient has delirium, does not, or if results are uncertain. Physicians at Oxford University, who developed the tests, studied the records of nearly 19,000 patients. In their JAMA article (paywall), they reported the screening was completed three-quarters of the time and that certain or possible delirium was found in about one-third of cases, which seems consistent with other research. Importantly, facilities that did not routinely use this screen found lower rates of delirium, which may imply they were missing cases. The research also found that patients with either certain or possible delirium were more likely to stay in the hospital longer, be discharged to institutional care, or die than those without the diagnosis. A related JAMA Internal Medicine commentary by Edward Marcantonio of the Harvard Medical School and Donna Fick of the Penn State School of Nursing concluded the screening method is sound. And they urged that any tests 'should be quick, accurate, equitable, acceptable to clinicians, integrated into routine workflow, and include robust and ongoing training and implementation of best practices for all older adults with delirium.' Families Should Be Alert Before treatment is needed, there may be ways to limit hospital-acquired delirium. For example, in the journal BMC Critical Care, Katarzyna Kotfis of the Pomeranian Medical University in Szczecin, Poland and co-authors described a radical new vision that they think could entirely eliminate delirium caused by ICU stays. Their model envisions a fundamental redesign of the units as well as limits on the use of sedatives. That may be ambitious, and Marcantonio has made more modest suggestions for addressing the environmental causes of dementia in hospital patients. They include carefully managing medications, getting patients out of bed, and making sure patient rooms are quiet and dark at night. They also urge hospitals to better communicate with family members about the diagnosis. In 2024, the American Psychiatric Association urged the government to designate delirium as a 'major complication,' which would make it easier for clinicians to get paid for treating it, a not-insignificant step in encouraging identification and treatment. Hospital-acquired delirium is common among older patients and has serious consequences. Patients' families need to be aware of it, and willing to say something if they see a change in cognition of their loved one. And hospitals need to do more to address it.
Medscape
11-06-2025
- Health
- Medscape
Head CT May Be Essential in Older Adults With Delirium
A study found that 1 in 6 older adults with delirium in the emergency department (ED) had abnormal findings on head CT, even without traditional risk factors for intracranial pathology. METHODOLOGY: Researchers conducted a secondary analysis of two prospective observational studies (one conducted from 2009 to 2012 and the other from 2012 to 2014) involving a total of 160 patients with delirium, aged 65 years or older (median age, 76 years; 62.5% women; 20% non-White), at an urban, tertiary care academic hospital. The primary outcome measure was a "positive composite head CT," defined as any acute intracranial abnormality seen during the index hospitalization or a new neurologic diagnosis within 30 days of the patient's ED visit. Researchers evaluated the diagnostic performance of five commonly cited risk factors — including anticoagulant use, recent head trauma, focal neurologic deficits, headache, and altered level of consciousness — to determine their ability to identify patients needing head CT. A secondary analysis was conducted to assess the diagnostic performance of six less common risk factors: Current antiplatelet use, current aspirin use, new or worsening seizures, history of brain hardware, recent falls, recent non-fall trauma, and vomiting secondary to trauma. TAKEAWAY: About 15.6% of older patients with delirium had a positive composite head CT. The absence of any common risk factors did not reduce the likelihood of a positive composite head CT (negative likelihood ratio [NLR], 0.6; 95% CI, 0.2-2.4), except for focal neurologic deficits, whose absence slightly lowered this likelihood (NLR, 0.6; 95% CI, 0.4-0.9). Only new or worsening seizures (positive likelihood ratio [PLR], 5.4; 95% CI, 0.8-36.6) and history of brain hardware (PLR, 5.4; 95% CI, 1.2-25.3) moderately increased the probability of having a positive composite head CT. IN PRACTICE: "Given that there is a high rate of abnormal head CTs, our study suggests that older ED patients with delirium should receive a head CT as part of the diagnostic workup, even in the absence of any risk factors," the authors wrote. SOURCE: The study was led by James O. Jordano, MD, Vanderbilt University Medical Center, Nashville, Tennessee. It was published online on May 16, 2025, in The American Journal of Emergency Medicine . LIMITATIONS: The study was limited by its single-center, secondary analysis design and small sample size. Reliance on retrospective chart review may have introduced misclassification of risk factors. Additionally, the exclusion of critically ill patients and the lack of enrollment during weekends and overnight hours may have introduced selection bias. DISCLOSURES: This study was funded by the National Institutes of Health, the National Center for Research Resources, and the National Center for Advancing Translational Sciences. The authors reported having no conflicts of interest.
Asharq Al-Awsat
03-06-2025
- Business
- Asharq Al-Awsat
Hezbollah: The Causes and Functions of Delirium
Doctors and analysts agree that delirium is a sudden change in the brain function that leads to disturbance and mental confusion. It often results from a transformation the body is subjected to; it could be surgery or withdrawal that follows long-term alcohol abuse. One of the more acute symptoms of delirium is inattention and reduced awareness of one's surroundings; the delirious can sometimes forget who he is, where he is, and what he is doing there. This can result in physiological disorientation, manifesting as either near-paralytic lethargy or an erratic. The statements coming from Hezbollah since the seismic change resulting from the 'support war' and its ramifications are strikingly delirious. One could probably say, albeit with some creative license, that an analogy could be drawn with both surgery and recovery from addiction. Indeed, one would think that the war, the operation, has reduced Hezbollah's triumphalist intoxication and its domineering behavior, challenging the party to adapt to this new reality. Yet, listening to Hezbollah Secretary-General Sheikh Naim Qassem (and some of the party's officials and spokesmen) set deadlines, speak of giving diplomacy and the government a chance, threaten to not extend these deadlines if they are not met, double down on the principle of 'the army, the people and the resistance,' deny defeat, and adamantly refuse to relinquish their weapons, one unequivocally concludes that its utter failure to adapt has reinforced its delirium. However, accuracy demands recognizing that this outcome is not without justification. Adaptation becomes exceedingly difficult when there has been something of a consensus, for over four decades, on idealizing the addiction. The binge that began in the early 1980s and ended only a few months ago had been presented as the epitome of sobriety, while those who refused to endorse this view were called on to treat their sick and scheming souls. The long-standing duality of arms, which allowed an illegitimate actor to make decisions of war and peace, was framed as the ultimate embodiment of prudence and the essence of truth. This extreme distortion had the upper hand in appointing presidents and ministers and shaping national policy and planning. As for the fact the party, without an official mandate, had constituted a parallel society that had been above and outside the state, and had branded others traitors at a whim, this had also seemed like its indisputable right. For years, Hezbollah was allowed to inform us that we were under threat as our senses and lived experiences were telling us the opposite, and it was allowed to warn us that we must resist, regardless of our desires, thoughts, or capabilities. Meanwhile, its subordinates were tasked with deciding which films must not be watched, and which books should not be translated or read, on our behalf. This makes the transition difficult. From a phase in which addiction ruled and delirium was indulged, forcing others to adapt to it, we are now entering a phase in which delirium is constrained and called by its real and dangerous names, while its authors are the ones expected to adapt. In other words, we are transitioning from an era in which reality had been made to accommodate addiction, to one in which the addict is now called upon to accommodate reality. And, without a doubt, that is extremely difficult. This delirium nonetheless remains functional. Iran will continue to find use for it so long as it is negotiating with Washington. Hezbollah's weapons are to remain in its hands and not handed over to the state; just as the Houthis' fireworks in Yemen, this bargaining chip must be maintained. Yet, everything seems smaller than it had once been: this applies just as much to the causes that are promoted as it does to material capacities and tools. The trajectory they have been on suggests that the war has led to decline and contraction, in parallel with Iran's own transformation from a frightening force with serious leverage to a fearful one desperately hanging on to its damaged cards. The contrast between the two phases could be summed up as follows: in the previous phase, a prime minister who went against the party and its patrons' wishes would be assassinated in a grand theatrical attack, and the ensuing investigation would be obstructed. In the current phase, the prime minister is spitefully and obscenely slandered a 'Zionist' for going against these wishes. This is not to downplay the gravity of what is happening today, especially in light of the recent municipal election results that showed this delirious consciousness can, even in defeat, obtain (for reasons too complex to unpack here) another mass pledge of allegiance. This is the case despite the immense costs of maintaining the allegiance - for the security of the Lebanese people, for their economy, for the country's reconstruction, and for the effort to ensure a national recovery. Those continuing to pledge allegiance may well ultimately end up hurting the most. This state of affairs cannot be allowed to continue, and it must not be tolerated. If all Lebanese are called upon to make great efforts, coupled with a reduction of provocations, to integrate a third of the population into a unified national project, then those directly concerned are the first to be called on to break away from a delusional and defeated project that cannot lead anywhere safe.
