Improving Anesthesia Management of Postoperative Delirium in Older Adults

Abstract

Purpose: The purpose of this quality improvement project (QIP) was to develop an educational presentation about postoperative delirium in the older adult undergoing surgery with the intent to improve anesthesia provider knowledge. There were two aims: the first to determine gaps of knowledge by surveying providers on current practice for future educational presentations and the second to educate providers about risk factors and intraoperative management of POD with a goal of improving outcome for this vulnerable population.Background: POD is generally defined to be a fluctuation in attention and disordered thought patterns, resulting in an alteration of cognition and awareness which appear within the immediate postoperative phase when recovering from anesthesia. The sequalae of POD are considered extensive, resulting in familial burden, reduced quality of life, longer lengths of hospitalization, increased healthcare costs, and an elevated risk of mortality. Educating anesthesia providers about the risk factors, symptoms, diagnostic tests, and preventative strategies of POD can be beneficial when planning their anesthetic plan for the older adult. Methods: An educational virtual presentation was distributed via email to anesthesia providers (n=20) at a hospital in northern Scottdale, Arizona. Participants viewed the video, then completed a brief survey that evaluated their current practice and their knowledge about POD. Participants had 14 days to watch the video and complete the survey. Data was sent to Qualtrics, and analysis was evaluated. Results: A total of 7 surveys (35% response rate) were submitted within the data collection period. The final analysis resulted in 85.7% of respondents (n=6) reporting that they felt the educational presentation increased their knowledge level and they plan on incorporating the use of dexmedetomidine, a preventative medication, in their practice going forward. For the sections that evaluated knowledge, participants had an accuracy rate of 86%, indicating that most of the participants answered the knowledge-based questions correctly. Gaps in current practice include omission in usage of the bispretral index monitor and lack of importance of changing their anesthesia plan when caring for the older adult in preventing POD. Conclusions: The accuracy rate of correct knowledge-based question responses indicates that providers possess a strong knowledge of postoperative delirium. however, it is difficult to be certain if the knowledge is because of current knowledge of the topic or due to knowledge gained from the presentation. Areas were identified to address future anesthetic recommendation’s such as the BIS monitor and regional anesthesia as well as a POD risk assessment tool to be used for all patients over age 65. Future educational presentations about POD is needed on a continuous basis.