Feasibility of Alerting Systems and Family Care Partner Support for Postoperative Delirium Prevention.

Autor:	Vlisides PE; Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI.; Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI., Runstadler N; Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI., Martinez S; Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI., Ragheb JW; Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, FL., Mentz G; Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI., Leis A; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI., Schoettinger A; Department of Social Work, University of Michigan., Hickey K; Department of Nursing, Michigan Medicine, Ann Arbor, MI., McKinney A; Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI., Brooks J; Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, MI., Zierau M; College of Health Professions, University of Detroit Mercy, Detroit, MI., Norcott A; Department of Internal Medicine, Division of Geriatric and Palliative Medicine, Michigan Medicine, Ann Arbor, MI.; Department of Internal Medicine, Division of Geriatric and Palliative Medicine, Michigan Medicine, Ann Arbor, MI., Mody L; Department of Internal Medicine, Division of Geriatric and Palliative Medicine, Michigan Medicine, Ann Arbor, MI., Inouye SK; Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA.; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA., Avidan MS; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO., Min L; Department of Internal Medicine, Division of Geriatric and Palliative Medicine, Michigan Medicine, Ann Arbor, MI.; Geriatric Research Education and Clinical Care, Veterans Affairs Arbor Healthcare System, Ann Arbor, MI.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgical anesthesiology [J Neurosurg Anesthesiol] 2024 Dec 19. Date of Electronic Publication: 2024 Dec 19.
DOI:	10.1097/ANA.0000000000001016
Abstrakt:	Background: The objective of this study was to determine whether postoperative pager alerts to the Hospital Elder Life Program (HELP), a delirium prevention service, would accelerate program enrollment for older surgical patients. This study also tested feasibility of family care partner interventions for delirium prevention. Methods: This single-center, pilot clinical trial factorially randomized 57 non-cardiac surgical patients ≥70 years of age to 4 arms: (1) standard care, (2) pager alerts to accelerate HELP enrollment, (3) family care partner-based delirium prevention interventions, or (4) a combined arm with both HELP and family interventions. The primary clinical outcome was delirium (assessed through the Confusion Assessment Method). Results: In the pager alerting arms, 13/24 (54%) participants were enrolled by HELP on postoperative day 1 compared with 0/26 (0%, P<0.001) in the non-alerting arms. Median [interquartile range] time spent in delirium prevention protocols was significantly longer in pager alerting arms than in non-alerting arms (39 [5 to 75] min vs. 0 [0 to 0] min; P<0.001). Family care partners spent 18 [11 to 25)] hours at the bedside over the first 3 postoperative days. There was no significant difference in delirium occurrence in participants randomized to pager alert arms compared with non-alerting arms (odds ratio, 1.02, 95% CI, 0.97-1.07; P=0.390). Similarly, there was no significant difference in delirium occurrence in family intervention arms compared with nonintervention arms (odds ratio, 0.97; 95% CI 0.93-10.02; P=0.270). Conclusions: Pager alerts significantly reduced time to HELP enrollment, albeit without reducing delirium incidence in this pilot study. Family care partners spent substantial time at the bedside during the study period. Competing Interests: P.E.V., A.M., and L.M. receive support from Blue Cross Blue Shield of Michigan (Detroit, MI) for quality improvement initiatives related to delirium. P.E.V. is a member of the Editorial Board of the Journal of Neurosurgical Anesthesiology. The remaining authors have no conflicts of interest to declare. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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