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.

中文翻译：

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自动术后谵妄风险预测工具结合非药物谵妄预防对谵妄发生率和住院时间的好处：基于质量改进项目的前后分析。


背景 术后谵妄 （POD） 对老年手术患者有重大影响，需要有效的预防策略。目的 评估干预前预防风险评估 （PIPRA） 自动谵妄风险预测工具和非药物预防策略对 POD 发生率、住院时间 （LOS） 和护理时间的有效性。方法 该质量改进项目在一家拥有 335 个床位的瑞士私立医院进行，采用前后设计来评估 PIPRA 和预防措施对 60 岁或以上非心脏和非颅内手术住院患者的 POD、LOS 和护理时间的影响。控制阶段侧重于加强 POD 筛查，而干预阶段则纳入 PIPRA 进行风险评估和员工培训，以便对高危患者进行有针对性的非药物预防。结果 共纳入 866 例患者;299 例对照和 567 例干预。调整基线患者特征时，干预组与对照组相比，POD 的比值比为 0.71 [95% 置信区间 （CI） 0.44-1.16]。干预的 LOS 为 0.94 （95% CI 0.85-1.05） 和护理时间是对照组的 0.96 （95% CI 0.86-1.07），根据基线患者特征进行调整。中度风险患者 （21.6% 的患者） 的 LOS 为 0.74 （95% CI 0.59-0.92），所需护理时间是对照组的 0.79 （95% CI 为 0.62-1.00） 倍，根据基线患者特征进行调整，相当于 LOS 减少 1.36 天，每位患者节省 19.3 小时的护理时间。结论 与对照组相比，干预组中危患者的 LOS 和护理时间更短，强调了针对性预防的重要性。