When should I consider referring a patient with delirium to secondary care for further evaluation and management?

Consider referring a patient with delirium to secondary care when there is doubt about the diagnosis, such as difficulty distinguishing between delirium, dementia, or delirium with dementia, and manage the delirium first ¹.

Refer if the person has severe delirium, such as being severely agitated or distressed ¹.

Seek advice from an elderly care consultant or psychiatrist if there is a need for further assessment, especially when there is doubt about the diagnosis, or if the person has challenging behaviour, or if detention under the Mental Health Act is being considered ¹.

Refer if further investigations that are not available in primary care are needed ¹.

Refer if the person does not respond to initial treatment in primary care or if they deteriorate ¹.