Persistent delirium without identified reversible cause in ED
New serious diagnosis
Pneumonia
Sepsis
Stroke
CNS infection
Unsafe discharge environment
No reliable supervision
High fall risk
Need for IV therapy
IV antibiotics
IV fluids with monitoring
Observation pathway
Transient delirium with reversible cause treated
Need for short interval reassessment after sedation
Mild infection treated with stable vitals
Discharge criteria
Return to baseline cognition
Vitals stable for 2 to 4 hours
Reversible cause treated or ruled out with a plan
Reliable caregiver present
Clear follow up within 24 to 72 hours
Discharge Instructions
Copy discharge instructions
Discharge instructions
Today you were seen for confusion
Your symptoms were consistent with delirium
Delirium can come and go and is often caused by a medical problem
Take your medications exactly as prescribed
Do not drink alcohol
Do not use recreational drugs
Do not drive until you are back to normal and cleared if needed
Drink fluids regularly unless you were told to restrict fluids
Arrange supervision by a trusted adult for the next 24 hours
Follow up with your family doctor within 1 to 3 days
Return to the emergency department now for any of the following
Fever
Worsening confusion
New weakness
Trouble speaking
Severe headache
Seizure
Fainting
Chest pain
Trouble breathing
Inability to keep fluids down
References
Guidelines and tools
Core references
American Geriatrics Society clinical practice guideline for postoperative delirium in older adults, 2015
NICE Delirium prevention diagnosis and management guideline, 2019 update
Society of Critical Care Medicine PADIS guidelines for pain agitation delirium immobility and sleep disruption, 2018
IDSA guidelines for bacterial meningitis management, 2004 with local protocol dependent updates
AHA ASA acute ischemic stroke guidelines, 2019 update
Confusion Assessment Method validation studies, original and subsequent validation cohorts
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.