Postoperative Delirium Screening in Older Adult Surgical Patients

Abstract

Problem & Purpose: Postoperative delirium occurs in up to 65% of older adult surgical patients and is associated with increased morbidity and mortality, increased length of hospital stay, and significantly increased healthcare costs. Perioperative leadership at a 275-bed advanced tertiary care hospital has stated considerable concern regarding the delirium noted in postoperative older adult patients. The purpose of this quality improvement project was to implement use of the Mini-Cog screening tool in a same-day surgery preoperative unit to identify outpatients aged 60 years and older that are at high risk for postoperative delirium and evaluate the compliance of screening. Methods: The Mini-Cog screening tool was implemented into the preoperative intake process of older adult surgical outpatients presenting to the same day surgery unit. The screening was conducted by anesthesia personnel to identify patients who possess a high risk of postoperative delirium and screening results were documented in a premade packet. Each patient’s respective postoperative delirium risk was used to create a tailored anesthetic plan with consideration of avoiding delirium-causing agents. Data collected, via chart audits of daily surgical case list and completed postoperative delirium packets, included compliance of Mini- Cog screening and the number of screened patients who were identified as high-risk for postoperative delirium. Univariant analysis, including percentages, were used to measure compliance to postoperative delirium screening. Results: Preoperative Mini-Cog screening compliance was 49.2% (60/125) and 18.3% (11/60) were identified as being high-risk for postoperative delirium. Conclusion: Preoperative implementation of the Mini-Cog screening tool to identify older adult surgical patients at high risk for POD is feasible and helps ensure the highest quality of care delivery. Adequate number and availability of screening personnel is paramount to screening the maximum number of eligible patients.