Gordon West (Annenberg Center for Health Sciences at Eisenhower); Eric Peterson (Annenberg Center for Health Sciences at Eisenhower); Philip Dombrowski (Annenberg Center for Health Sciences at Eisenhower); Anna Moll (Annenberg Center for Health Sciences at Eisenhower)

Synopsis

Post-surgical delirium (PSD) is common among older patients and is known to double the length of stay compared to similar patients without PSD. PSD is also associated with long-term sequelae including earlier onset of dementia, earlier nursing home placement, and earlier death. Multiple risk factors increase the risk of developing PSD including existing cognitive impairment, lack of functional reserve, and general health status. Eisenhower Medical Center formed an intraprofessional team to study the issue, design, and test a system aimed at reducing the incidence of PSD.

Body

Members of several professions met regularly to examine current incidence of PSD, review the literature, and consider potential solutions. The team sought the technical expertise of an outside expert. Working within a quality improvement framework the team developed interventions including the following:

• Cognitive screening for elderly patients scheduled for high-risk orthopedic procedures
• Design of a computerized “Care Alert” to notify the PSD Team with patients admitted through the ED with a hip fracture meet high-risk criteria
• Guidelines related to pain control, fluid management, and use of certain drugs
• Nursing interventions designed to prevent PSD
• Nursing assessments to immediately identify and manage delirium when it occurs

These interventions are currently being implemented. The following outcomes will be measured:

• Length of stay
• Episodes of delirium
• Length
• Severity
• Falls

Funding Sources

Funding for this activity was provided in part by a grant from Pfizer.