‘Evaluation of the ‘renewed approach to delirium’ project at the cardiothoracic surgery ward.’

Abstract

Introduction. Postoperative delirium after cardiac surgery is a common but frequently unrecognized complication in hospitalized patients, typically occurring within the first three postoperative days. This study evaluates the implementation of the quality improvement project ‘renewed approach to delirium’ initiated in June 2022 at the Cardiothoracic Surgery Department in Catharina Hospital Eindhoven. The project aimed to improve the identification and management of postoperative delirium in cardiac surgery patients. Methods. We used a mixed-methods study design with a primary quantitative phase, including semi-structured interviews for the evaluation of the project. The study included high-risk patients of postoperative delirium, analyzed from July 2022 to May 2023. We retrieved the number of VMS, DOSS, and DeltaScan measurements to assess the adherence to the project. Results. We analyzed 156 patients (mean age 72.4 years). Preoperative VMS was performed in nearly all patients (98.1%), of which 11.5% showed an increased risk of delirium. The total number of adequate measurements was 7.7% and 39.7% for the DOSS and DeltaScan, respectively. Additionally, there is an increasing trend in the number of measurements. Discussion. Our findings indicate suboptimal adherence to the quality improvement project. Challenges include a lack of understanding, time constraints, and issues related to acceptability and adoption. Inadequate adherence may compromise delirium detection and overall patient care quality, potentially leading to delayed interventions, extended hospital stays, increased healthcare costs, and a higher risk of adverse patient outcomes, including persistent cognitive impairment and institutional care needs upon discharge.