Anesthetic Practice Trends and Perceptions Toward Postoperative Delirium: A Mixed-Methods Analysis

Ragheb, Jacqueline; Norcott, Alexandra; Iskander, Mina; Brooks, Joseph; McKinney, Amy; Mentz, Graciela; Vlisides, Phillip E.

doi:10.1213/ane.0000000000006020

Cited by 3 publications

(2 citation statements)

References 38 publications

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“…Focus groups were conducted -and coded -by study team physicians (one male, one female) with prior focus group experience (J.R. and P.E.V.) using previously described methods [20]. These physicians lead a clinical research program that aims to optimize neurocognitive health in hospital inpatient settings.…”

Section: Methodsmentioning

confidence: 99%

Barriers to delirium screening and management during hospital admission: a qualitative analysis of inpatient nursing perspectives

Ragheb,

Norcott,

Benn

et al. 2023

BMC Health Serv Res

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Background Delirium in hospitalized patients is a major public health issue, yet delirium is often unrecognized and missed during inpatient admission. The objective of this study was to identify barriers to delirium screening, identification, and management from a nursing perspective on inpatient, acute care units. Methods This was a pre-implementation, diagnostic evaluation study to determine current practice patterns and potential barriers to optimizing delirium care at a major university hospital. A qualitative approach was used, which included focus groups of inpatient nurses working on major medical and surgical acute care units. Focus groups were conducted until signs of thematic saturation were present, and data were analyzed via inductive thematic analysis, without predetermined theories or structures. A consensus approach was utilized for transcript coding, and final themes were generated after multiple reviews of initial themes against transcript datasets. Results Focus group sessions (n = 3) were held with 18 nurses across two major inpatient units. Nurses reported several barriers to successful delirium screening and management. Specific challenges included difficulty with using delirium screening tools, an organizational culture not conducive to delirium prevention, and competing clinical priorities. Proposed solutions were also discussed, including decision-support systems with automated pager alerts and associated delirium order sets, which may help improve delirium care coordination and standardization. Conclusion At a major university hospital, nurses affirm the difficulty experienced with delirium screening and identification, particularly due to screening tool challenges, cultural barriers, and clinical workload. These impediments may serve as targets for a future implementation trial to improve delirium screening and management.

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Section: Methodsmentioning

confidence: 99%

Barriers to delirium screening and management during hospital admission: a qualitative analysis of inpatient nursing perspectives

Ragheb,

Norcott,

Benn

et al. 2023

BMC Health Serv Res

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“…Process measurement and compliance is important to increase the quality of care and therefore value, as even when evidence-based best practices are identified they may not be implemented. For example, previous studies have shown that few institutions “always” follow the Brain Trauma Foundation guidelines8 when managing patients with traumatic brain injury, nearly half of anesthesiologists were unaware of delirium prevention guidelines,9 and higher compliance with Enhanced Recovery After Surgery (ERAS) protocols was associated with improved outcomes 10. Ultimately, QI needs to be linked to relevant outcomes and cost efficiency to effectively drive value 6…”

Section: Value-based Health Care and Qi: Concepts And Frameworkmentioning

confidence: 99%

Value-based Care and Quality Improvement in Perioperative Neuroscience

Luoma

Flexman

2022

Journal of Neurosurgical Anesthesiology

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Value-based care and quality improvement are related concepts used to measure and improve clinical care. Value-based care represents the relationship between the incremental gain in outcome for patients and cost efficiency. It is achieved by identifying outcomes that are important to patients, codesigning solutions using multidisciplinary teams, measuring both outcomes and costs to drive further improvements, and developing partnerships across the health system. Quality improvement is focused on process improvement and compliance with best practice, and often uses "Plan-Do-Study-Act" cycles to identify, test, and implement change. Validated, standardized core outcome sets for perioperative neuroscience are currently lacking, but neuroanesthesiologists can consider using traditional clinical indicators, patient-reported outcomes measures, and perioperative core outcome measures. Several examples of bundled care solutions have been successfully implemented in perioperative neuroscience to increase value; for example, enhanced recovery for spine surgery, delirium reduction pathways, and same-day discharge craniotomy. This review proposes potential individualand system-based solutions to address barriers to value-based care and quality improvement in perioperative neuroscience.

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Predicting the needle in the haystack: Considerations for modeling low-frequency events

Tumin

Vasilopoulos

2022

Journal of Clinical Anesthesia

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Anesthetic Practice Trends and Perceptions Toward Postoperative Delirium: A Mixed-Methods Analysis

Cited by 3 publications

References 38 publications

Barriers to delirium screening and management during hospital admission: a qualitative analysis of inpatient nursing perspectives

Barriers to delirium screening and management during hospital admission: a qualitative analysis of inpatient nursing perspectives

Value-based Care and Quality Improvement in Perioperative Neuroscience

Predicting the needle in the haystack: Considerations for modeling low-frequency events

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