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Clin Interv Aging. 2019 Dec 9;14:2125-2135. doi: 10.2147/CIA.S230800. eCollection 2019.

Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers.

Author information

1
Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany.
2
Geriatric Center, University Hospital Tübingen, Tübingen 72076, Germany.
3
Department of Old Age Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Germany.
4
Department of Social and Preventive Medicine, University of Potsdam, Potsdam, Germany.

Abstract

Purpose:

Postoperative cognitive dysfunction (POCD) appears in up to 30% of patients suffering from postoperative delirium (POD). Both are associated with higher mortality and postoperative complications, prolonged hospital stays, and increased costs. Multi-modal models with pre-admission risk reduction counselling, perioperative monitoring, and training of multidisciplinary patient care providers have been shown to decrease the prevalence of both. The aim of our study is to understand how far those measures are known and implemented in routine care and to detect potential gaps in the current practice regarding risk communication and information flow between involved caregivers for patients at risk for POD/POCD.

Patients and Methods:

As part of a multicenter study, seven semi-structured focus group (FG) discussions with nurses and physicians from tertiary care hospitals (surgery, anesthesiology, and orthopedics, n=31) and general practitioners (GPs) in private practice (n=7) were performed. Transcribed discussions were analyzed using qualitative content analysis.

Results:

POD is present above all in the daily work of nurses, whereas physicians do not perceive it as a relevant problem. Physicians report that no regular risk assessment or risk communication was performed prior to elective surgery. Information about POD often gets lost during hand-offs and is not regularly reported in discharge letters. Thus, persisting cognitive dysfunction is often missed. The importance of standardized documentation and continuous education concerning risks, screening, and treatment was emphasized. The often-suggested pre-OP medication adjustment was seen as less important; in contrast, avoiding withdrawal was regarded as far more important.

Conclusion:

Altogether, it seems that standards and available best practice concepts are rarely implemented. In contrast to physicians, nurses are highly aware of delirium and ask for standardized procedures and more responsibility. Therefore, raising awareness regarding risks, screening tools, and effective preventive measures for POD/POCD seems an urgent goal. Nurses should have a central role in coordination and care of POD to prevent the risk for POCD.

KEYWORDS:

POCD; clinical pathways; cross-sectoral care; delirium prevention; dementia; postoperative cognitive dysfunction; risk screening

Conflict of interest statement

Mrs L Bertram reports grants from Innovationfonds outside the submitted work. Prof. Dr. G Eschweiler reports grants from Innovationsfonds PAWEL, during the conduct of the study. Dr C Thomas reports grants from Innovation fund G-BA, during the conduct of the study. Prof. Dr. M Rapp reports grants from BMBF during the conduct of the study and personal fees from Willmar Schwabe GmbH outside the submitted work. The authors report no other conflicts of interest in this work.

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