Quality Contract for the Prevention of Postoperative Delirium

Abstract

Delirium is one of the most common postoperative complications. Delayed initiation of treatment leads to an increased mortality rate within the first 90 days and to an increased need for post-hospital care. Similarly, neurocognitive disorders (NCDs) occur in a quarter of affected patients over the long-term. The use of evidence-based guideline recommendations can reduce incidence rates of delirium, shorten delirium duration, and prevent complications. Implementing delirium management according to evidence-based guideline recommendations requires a transformation process that integrates all stakeholders. In May 2017, the Federal Joint Committee (G-BA), the highest decision-making body in the German healthcare system, approved the quality contract (QC) as a new instrument for improving healthcare in Germany. With QC, hospitals have the opportunity to set up better conditions for the transformation process of delirium management, because with QC funding, initial hurdles can be more easily overcome, such as establishing and sustaining new structures or mobilizing resources. The cooperation of all stakeholders - but above all their shared understanding - of the need for transformation is crucial for the successful implementation of delirium management. The digitization of cross-departmental processes in particular is an elementary component in a modern transformation process. This creates new opportunities and processes that offer added value for patients and caregivers. Patients thus experience delirium management as a coherent interdisciplinary and multiprofessional concept that is implemented transparently, comprehensibly, and evidence-based.