On behalf of the Commission, I would like to welcome you and thank you for joining us
today for today's launch.
We hope that this will be the beginning of an important journey to improve the diagnosis
and the outcome of people suffering from delirium.
As you’ve already heard, it's not such an isolated event.
I guess once upon a time delirium was thought to be something that occurred in nursing homes
or with elderly people, and there wasn’t very much you could do about it other than
to give them some form of sedative.
So you really just kept them quiet without actually dealing with the underlying problems.
You might say well what's the Clinical Care Standard all about?
Well the Clinical Care Standard is really nothing more, in a way, than a number of nationally
agreed quality statements that describe the care health professionals and health services
should be providing to patients for a specific clinical condition or defined part of a clinical
pathway in line of best evidence that's currently available.
And I guess that's the other important thing.
Nothing stands still in medicine.
We are always looking for change, but the important thing, I think, is to evaluate that
change so that it does become something that improves outcome rather than something that
we think might be simply a good idea.
So what will a Clinical Care Standard do as far as benefit is concerned, because obviously
this does need to be beneficial.
Well as you already heard from Sophie, delirium is probably much more common than many people
might believe.
And the other thing, of course is, that there seems to be fairly good evidence that it is
increasing.
Now this might not be due to an absolute increase, but just due to the fact that we are now more
able to recognise or perhaps even more willing to recognise delirium as a cause of major
problems.
But as you've heard some ten percent (10%) of Australians do suffer from delirium and
that increases quite markedly if they’re unfortunate enough to be admitted to hospital.
And it's not just the sick, frail, and elderly that it's a problem to, because there’s
now very compelling evidence that individuals who are considered fit for things like cardiac
surgery or hip replacement or joint replacement are admitted to hospital, then up to thirty
percent (30%) of those individuals can actually suffer from delirium during their time in
hospital.
So it's not that you’ve got people who are unfit, presumably we're not doing cardiac
surgery or orthopaedic surgery on individuals who are very frail and therefore not easily
able to deal with the issues arising from their treatment.
So you can see that this isn't by any means uncommon and certainly is often associated
with admission to hospital for relatively routine procedures.
And as you have already heard then there’s a whole list of things that seems to be associated
with the diagnosis and the presence of delirium.
There's increased mortality, more adverse events, and these are the sorts of issues
I think we’ve seen for years: people falling out of bed, infections, and pressure injuries.
Now those things are going to create enormous problems for the recovery of those individuals
that suffer from them and it's been the delirium which has been the driver for those events
to occur.
And obviously when you get those complications in hospital then, of course, there's going
to be longer hospital stays.
There's often going to be more unplanned re-admissions to hospital.
But I think sadly, often this leads to earlier admission to residential care facilities.
And this really does, I think, no matter how good the residential care facilities are,
has a significant impact on the quality and the mobility of the life of those individuals
that do end up having to be dealt with and looked after in a residential care facility.
The other issue, I guess, that we hope that this standard will improve is that delirium
is often not detected, it's dismissed or misdiagnosed, and it's absolutely critical to be able to
differentiate or to distinguish delirium from dementia and to investigate it properly as
it may be the only sign of an acute underlying serious illness.
So from that point of view it's extremely important that it is detected and it is managed.
And this I think is one of the things that we do need to understand that often when a
patient is diagnosed with delirium it's so important to have been able to talk with their
family, their relatives to make sure we understood what they were like before they came into
hospital, to make sure that this is a change—a significant change—and sometimes it's just
put down as dementia and it's always been there so let's not worry about it.
So I think from that point of view unless we do talk to the families, talk to their
relatives and make sure that they’re engaged all the time with what we’re doing, we’re
not going to achieve the outcomes that I think we would like to do.
The other thing, of course, is that we have to inform the community.
We have established a fact sheet which we can provide to the consumers and clinicians
and to help to support implementation and also what we have is a set of indicators for
health services to review the performance of their own organisation and to make improvements
in the care they provide.
And I think personally this is one of the great weaknesses of our health system is we
do not measure our outcomes.
We often don't know what the outcome of our treatment is.
We feel it's good enough to have actually enacted the treatment and let's assume we
all do well and we get good results, but basically that's not always the case.
And so we believe it's so important that if we're going to continue to improve the care
of the patients with delirium, we do need to have the ability to measure what is happening,
to record it, and then to assess it, and make sure that we look for where we’re failing
or falling down in our treatment so that we can continue to improve it.
So assessment of our treatment to my mind is just so important.
And so, we are hopefully, today, on the beginning of a very important journey, but we could
never have started this journey if it hadn't been for the support of the various groups
that joined the Delirium Topic Working Group.
And on the behalf of the Commission, I thank each and every one of them and their associate
organisations for the time and the effort that they put into this,because this is really
about, I think, the families or the family of health professionals coming together, recognising
there's a problem, and spending countless hours trying to look at how we can overcome
or improve the outcome of patients who are suffering from delirium.
So today, thank you all for joining us.
It's my pleasure, of course, today, to launch the Delirium Clinical Care Standard.
May it serve our community well.
Thank you.