The pitfalls when managing patients with delirium are:

  • Failure to consider the diagnosis, particularly the hypoactive subtype
  • Failure to routinely assess the mental state of all elderly patients in the ED
  • Failure to obtain a corroborating history from relatives, carers or friends. This is particularly important when trying to distinguish between delirium and dementia
  • Failure to obtain a full drug history
  • Failure to appreciate that injury (particularly head injury) and pain are important causes of acute confusion
  • Requesting insufficient or inappropriate investigations. A full set of all blood tests/x-rays/CT scans is not needed in the initial management of many patients
  • Failure to appreciate that environmental factors are vitally important in the prevention and treatment of delirium
  • Avoid sedating patients unless absolutely indicated