Introduction: Delirium is common in patients who are critically ill and associated with increased mortality and long-term cognitive impairment. The objective of this study was to explore the barriers and facilitators to the use of existing ICU delirium identification tools and implementation of care protocols.
Methods: Semi-structured interviews were conducted with healthcare professionals working in UK NHS ICUs. Purposive sampling was utilised to recruit a diverse range of participants to account for profession; user status of delirium identification tools or care packages; size of unit; and UK location. Thematic analysis was undertaken using the Theoretical Domains Framework.
Results: Twenty-one ICU healthcare professionals were interviewed from 20 hospitals. Participants included consultants (n = 9); nurses (n = 8); advanced critical care practitioners (n = 2); and allied health professionals (n = 2). Five major barriers to effective delirium care emerged: lack of prioritisation; lack of structured ICU delirium care protocols; inability to implement interventions due to physical space constraints and/or lack of resources; loss of experienced staff; and changes in ICU nursing culture. Facilitators included the presence of clear protocols; continued staff training; increased awareness; delirium champions; post-ICU follow-up clinics; family engagement; effective communication; and the use of digital prompts as a component of mandatory electronic documentation.
Discussion: Although ICU delirium is acknowledged as being important by clinical staff, management is often hindered by systemic and cultural barriers. Healthcare professionals highlighted the need for protocol-driven care, enhanced training and awareness, and the inclusion of families in care processes. These findings will inform the design of a multicomponent care package to improve delirium care in the ICU.
Keywords: delirium; intensive care unit; qualitative; theoretical domains framework.
Delirium is a health issue where people become very confused or act strangely because of another health problem, such as an operation or an infection. It is common in intensive care units, where very ill people are treated. People who get delirium need to stay in hospital for longer. They may also have problems with thinking and memory after they leave hospital. This study was part of a project to make a new care plan to prevent and treat delirium in intensive care units. Researchers spoke with 21 doctors, nurses and other staff from 20 intensive care units in the UK. They asked about how staff spot delirium, prevent it and care for patients with it. The goal was to understand what helps and what gets in the way. The study found five problems: some doctors and nurses don't see delirium as important; many ICU units don't have clear plans to how to deal with delirium; many units don't have enough staff; experienced staff are leaving; and nurses are now doing more technical tasks instead of traditional caring roles. But the study also found things that can help. For example, having a clear care plan for delirium, training staff often and making them aware of delirium, or having staff who just focus on delirium can help. Also, good communication, setting reminders for staff to check on patients, involving families in care and checking on patients after they go home. In short, most doctors and nurses know that delirium matters but they struggle to deal with it properly. To make things better, intensive care units need clear care plans, more training and more family involvement.
© 2025 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.