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 NICE CKS.
Refer if the person has severe delirium, such as being severely agitated or distressed NICE CKS.
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 NICE CKS.
Refer if further investigations that are not available in primary care are needed NICE CKS.
Refer if the person does not respond to initial treatment in primary care or if they deteriorate NICE CKS.