术后谵妄风险自动预测工具与非药物谵妄预防相结合对谵妄发生率和住院时间的益处:基于质量改进项目的前后分析。

IF 6 2区 医学 Q1 GERIATRICS & GERONTOLOGY Age and ageing Pub Date : 2024-10-01 DOI:10.1093/ageing/afae219
Benjamin T Dodsworth, Kelly A Reeve, Martin Zozman, Philipp Meier, Felix Buddeberg, Marius Möller, Simone Pascale Wildhaber, Mary-Anne Kedda, Sönke Böttger, Reto Stocker, Nayeli Schmutz Gelsomino
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引用次数: 0

摘要

背景:术后谵妄(POD)严重影响老年手术患者:术后谵妄(POD)对老年手术患者的影响很大,需要采取有效的预防策略:评估介入前预防风险评估(PIPRA)自动谵妄风险预测工具与非药物预防策略对 POD 发生率、住院时间(LOS)和护理时间的效果:该质量改进项目在瑞士一家拥有 335 张病床的私立医院开展,采用前后对比的设计方法,评估 PIPRA 和预防措施对 60 岁及以上非心脏和非颅内手术住院患者的 POD、住院时间和护理时间的影响。对照阶段侧重于加强 POD 筛查,而干预阶段则将 PIPRA 用于风险评估和人员培训,以便对高危患者进行有针对性的非药物预防:共纳入 866 名患者,其中对照组 299 人,干预组 567 人。在调整患者基线特征后,干预组与对照组相比,POD 的几率比为 0.71 [95% 置信区间 (CI) 0.44-1.16]。经调整患者基线特征后,干预组的生命周期是对照组的 0.94 倍(95% 置信区间:0.85-1.05),护理时间是对照组的 0.96 倍(95% 置信区间:0.86-1.07)。中危患者(占患者总数的 21.6%)的 LOS 为对照组的 0.74(95% CI 0.59-0.92)倍,所需的护理时间为对照组的 0.79(95% CI 0.62-1.00)倍,调整基线患者特征后,相当于每位患者的 LOS 缩短了 1.36 天,护理时间节省了 19.3 小时:与对照组相比,干预组的中危患者的住院时间和护理时间更短,这凸显了有针对性预防的重要性。
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Benefits of an automated postoperative delirium risk prediction tool combined with non-pharmacological delirium prevention on delirium incidence and length of stay: a before-after analysis based on a quality improvement project.

Background: Postoperative delirium (POD) significantly impacts older surgical patients, necessitating effective prevention strategies.

Objective: To assess the effectiveness of the Pre-Interventional Preventive Risk Assessment (PIPRA) automated delirium risk prediction tool alongside non-pharmacological prevention strategies on POD incidence, hospital length of stay (LOS) and nursing time.

Methods: This quality improvement project, set in a 335-bed Swiss private hospital, employed a before-after design to evaluate the impact of PIPRA and preventive measures on POD, LOS and nursing time in non-cardiac and non-intracranial surgery inpatients aged 60 or older. The control phase focused on enhancing POD screening, whilst the intervention phase incorporated PIPRA for risk assessment and staff training to enable targeted non-pharmacological prevention in patients at risk.

Results: A total of 866 patients were included; 299 control and 567 intervention. The odds ratio of POD, comparing the intervention group to the control, was 0.71 [95% confidence interval (CI) 0.44-1.16] when adjusting for baseline patient characteristics. The intervention was associated with an LOS 0.94 (95% CI 0.85-1.05) and nursing time 0.96 (95% CI 0.86-1.07) times that of the control, adjusted for baseline patient characteristics. Medium risk patients (21.6% of patients) had an LOS 0.74 (95% CI 0.59-0.92) and required nursing time 0.79 (95% CI from 0.62-1.00) times the control, adjusted for baseline patient characteristics, equivalent to an LOS reduction of 1.36 days and nursing time saving of 19.3 hours per patient.

Conclusions: Medium risk patients in the intervention group had shorter LOS and nursing time compared to the control group, underscoring the importance of targeted prevention.

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来源期刊
Age and ageing
Age and ageing 医学-老年医学
CiteScore
9.20
自引率
6.00%
发文量
796
审稿时长
4-8 weeks
期刊介绍: Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
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