Abstract
Patients following cardiac surgery commonly experience post-operative delirium (POD) during their postoperative hospital stay. A multifaceted, specialty wide, quality improvement (QI) project was undertaken for patients experiencing POD. The goal was to develop a reduction in POD care bundle (rPOD-a structured patient care program) that encompasses efficient preoperative risk factor identification and a postoperative patient-care process to ensure early POD identification and treatment. The following steps were taken to implement the rPOD care bundle including: (a) Developing a quality driven, evidence-based guideline for the perioperative cardiac surgery health care team, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education, and regular project evaluation. Trends of process measures and quality improvement measures were examined. An increasing trend in the rate of postoperative delirium screening during implementation of rPOD intervention was demonstrated. This quality improvement study provides a bases for future postoperative delirium reduction interventions.
Highlights
Delirium is an acute brain dysfunction characterized by a fluctuating disturbance of consciousness with inattention and cognition and perception deficits [1,2]
The global aim of this quality improvement project was to decrease the prevalence of postoperative delirium among cardiac surgery patients at our center
We carefully considered the steps involved in preparing the frontline staff through engaging all relevant stakeholders (ICCS, cardiac surgery in-patient unit (CSIU), cardiac pre-assessment clinic (CPAC) RN, Physician Assistant) in monthly, multidisciplinary, delirium working group meetings
Summary
Delirium is an acute brain dysfunction characterized by a fluctuating disturbance of consciousness with inattention and cognition and perception deficits [1,2]. Numerous studies among cardiac surgery patients have demonstrated that POD increases the risk of postoperative mortality and of prolonged length of hospital stay [5,6,7,8]. Such patients are at a higher risk of functional decline both physically and mentally, resulting in post-discharge poor quality of life, as well as a higher rate of nursing home placement [5,6,7,8]. There has been extensive research documenting the short- and long-term hazards associated with POD
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