Delirium Screening in the Emergency Department: Barriers, Enablers and Alignment With Clinical Standards-A Mixed-Methods Study.

objectiveDelirium is common and serious among older adults in emergency departments (EDs) yet screening often falls short of national expectations. This study evaluated current delirium screening practices in a metropolitan ED and identified barriers and enablers to implementing screening in line with the Australian Delirium Clinical Care Standard.

methodsA mixed-methods quality assurance study was conducted in The Prince Charles Hospital ED. A retrospective audit of 238 medical records for patients aged ≥ 65 years examined the frequency of delirium screening and associated clinical or operational factors. Semi-structured interviews with nine staff members explored perceptions, experiences and decision-making processes related to screening. Deductive framework analysis guided integration of quantitative and qualitative data.

resultsOf eligible patients, 4.2% were screened, with most assessments completed by specialist teams during weekday hours. Screened patients had longer ED stays, although this finding should be interpreted as exploratory. Nurses recognised major delirium risk factors but described screening as reactive rather than routine. Reported barriers included time pressures, environmental limitations, lack of digital integration and uncertainty about role responsibilities. Awareness of the Australian Delirium Clinical Care Standard was limited, contributing to inconsistent practice.

conclusionsDespite baseline knowledge of delirium risk, ED screening remains inconsistent and specialist-dependent. Strengthening adherence to national standards requires embedding screening into routine nursing workflows through clearer role delineation and the integration of prompts to support systematic assessment for all older patients.