Implementation of guidelines on delirium in the General Hospital: a before-after study of their impact on caregivers' knowledge and clinical skills

Delirium is a highly prevalent disorder, with serious con sequences for the hospitalised patient. Nevertheless, it remains under diagnosed and undertreated. We developed evidencebased clinical practice guidelines (CPGs) focusing on prevention, screening, diagnosis, and treat ment of delirium in a general hospital. This article presents the implementa tion process of these CPGs and a beforeafter study assessing their impact on healthcare professionals’ knowledge and on clinical practice. Methods: CPGs on delirium were first implemented in two wards (Neu rology and Neurosurgery) of the Lausanne university hospital. Interactive onehour educational sessions for small groups of nurses and physicians were organised. Participants received a summary of the guidelines and completed a multiple choice questionnaire, assessing putative changes in knowledge, before and three months after the educational session. Other indicators such as “diagnosis of delirium” reported in the discharge letters, and mean duration of patients’ hospital stay before and after implementa tion were compared. Results: Eighty percent of the nurses and physicians from the Neurol ogy and Neurosurgery wards attended the educational sessions. Both nurses and physicians significantly improved their knowledge after the implemen tation (+9 percentagepoints). Other indicators were not modified by the intervention. Conclusion: A single interactive intervention improved both nurses’ and physicians’ knowledge on delirium. Sustained and repeated interventions are probably needed to demonstrate changes in clinical practice.