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

H Sturm,1 R Wildermuth,1 R Stolz,1 L Bertram,1 GW Eschweiler,2 C Thomas,3 M Rapp,4 S Joos1 1Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany; 2Geriatric Center, University Hospital Tübingen, Tübingen 72076,...

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Autores principales:	Sturm H, Wildermuth R, Stolz R, Bertram L, Eschweiler GW, Thomas C, Rapp M, Joos S
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	cross-sectoral care delirium prevention postoperative cognitive dysfunction (pocd) dementia clinical pathways risk screening. Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/75ce8f45916541608030948ed26b0251
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spelling	oai:doaj.org-article:75ce8f45916541608030948ed26b02512021-12-02T05:20:16ZDiverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers1178-1998https://doaj.org/article/75ce8f45916541608030948ed26b02512019-12-01T00:00:00Zhttps://www.dovepress.com/diverging-awareness-of-postoperative-delirium-and-cognitive-dysfunctio-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998H Sturm,1 R Wildermuth,1 R Stolz,1 L Bertram,1 GW Eschweiler,2 C Thomas,3 M Rapp,4 S Joos1 1Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany; 2Geriatric Center, University Hospital Tübingen, Tübingen 72076, Germany; 3Department of Old Age Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Germany; 4Department of Social and Preventive Medicine, University of Potsdam, Potsdam, GermanyCorrespondence: H SturmInstitute for General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstr 5, Tübingen 72076, GermanyTel +49 7071 29 85269Fax +49 7071 29 5896Email heidrun.sturm@med.uni-tuebingen.dePurpose: 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: cross-sectoral care, delirium prevention, postoperative cognitive dysfunction, POCD, dementia, clinical pathways, risk screeningSturm HWildermuth RStolz RBertram LEschweiler GWThomas CRapp MJoos SDove Medical Pressarticlecross-sectoral caredelirium preventionpostoperative cognitive dysfunction (pocd)dementiaclinical pathwaysrisk screening.GeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 14, Pp 2125-2135 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	cross-sectoral care delirium prevention postoperative cognitive dysfunction (pocd) dementia clinical pathways risk screening. Geriatrics RC952-954.6
spellingShingle	cross-sectoral care delirium prevention postoperative cognitive dysfunction (pocd) dementia clinical pathways risk screening. Geriatrics RC952-954.6 Sturm H Wildermuth R Stolz R Bertram L Eschweiler GW Thomas C Rapp M Joos S Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers
description	H Sturm,1 R Wildermuth,1 R Stolz,1 L Bertram,1 GW Eschweiler,2 C Thomas,3 M Rapp,4 S Joos1 1Institute for General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany; 2Geriatric Center, University Hospital Tübingen, Tübingen 72076, Germany; 3Department of Old Age Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Germany; 4Department of Social and Preventive Medicine, University of Potsdam, Potsdam, GermanyCorrespondence: H SturmInstitute for General Practice and Interprofessional Care, University Hospital Tübingen, Osianderstr 5, Tübingen 72076, GermanyTel +49 7071 29 85269Fax +49 7071 29 5896Email heidrun.sturm@med.uni-tuebingen.dePurpose: 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: cross-sectoral care, delirium prevention, postoperative cognitive dysfunction, POCD, dementia, clinical pathways, risk screening
format	article
author	Sturm H Wildermuth R Stolz R Bertram L Eschweiler GW Thomas C Rapp M Joos S
author_facet	Sturm H Wildermuth R Stolz R Bertram L Eschweiler GW Thomas C Rapp M Joos S
author_sort	Sturm H
title	Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers
title_short	Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers
title_full	Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers
title_fullStr	Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers
title_full_unstemmed	Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers
title_sort	diverging awareness of postoperative delirium and cognitive dysfunction in german health care providers
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/75ce8f45916541608030948ed26b0251
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Diverging Awareness of Postoperative Delirium and Cognitive Dysfunction in German Health Care Providers

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