Development and implementation of a hospital-based delirium response system: A phased approach in a tertiary care center

초록

Background: Delirium is a common and serious neuropsychiatric condition among hospitalized older adults, associated with increased morbidity, mortality, and healthcare burden. Despite its clinical importance, delirium remains under-recognized and inadequately managed in many hospital settings, particularly in general wards where systematic screening and coordinated response systems are often lacking. Objectives: This study aims to describe the development and phased implementation of a hospital-based delirium response system in a tertiary care center, and to explore its role in improving early detection, response timeliness, and coordination of care. Methods: A multidisciplinary delirium response system was developed, incorporating nurse-led routine screening using the Nursing Delirium Screening Scale (Nu-DESC), structured consultation pathways, and specialist evaluation. The system was implemented in phases, including an initial pilot in a general ward, a period of interruption due to staffing constraints, and subsequent re-implementation with an expanded, team-based model involving psychiatric nurses and psychiatrists. This phased approach allowed for comparison of system performance across different operational conditions. Results: The implementation of the delirium response system facilitated earlier identification of patients at risk of delirium and improved coordination between clinical teams. Preliminary observations suggest improvements in response timeliness and consistency of care following system implementation and re-implementation phases. The structured workflow enabled more efficient triage and timely specialist input. Conclusions: A phased, hospital-based delirium response system is feasible and may enhance system-level responsiveness to delirium in a tertiary care setting. This approach provides a practical and scalable framework for implementing delirium care pathways in general hospital wards. Future research should focus on quantitative evaluation of clinical outcomes and integration of automated monitoring systems to support real-time detection and intervention.