Background Postoperative delirium is an acute, fluctuating neurocognitive syndrome. It is among the most common perioperative complications in older patients and is associated with increased morbidity and mortality, a prolonged length of stay, complications, and persistent cognitive impairment. After major head and neck procedures, the risk is particularly high; risk factors often accumulate, including advanced age, pre-existing cognitive impairment, high American Society of Anesthesiologists (ASA) status, polypharmacy, malnutrition, and prolonged operative time. No established pharmacological primary therapy exists; early detection, prevention, and treatment of underlying causes are first line. Objective This work constitutes the initial implementation and testing of a process-oriented delirium management program in the departments of otorhinolaryngology (ENT) and ophthalmology of a university hospital. Methods A practice development project was carried out (2022–2024) to implement standardized delirium management in ENT and ophthalmology. It included risk stratification upon admission, monitoring using the Delirium Observation Screening Scale, and non-pharmacological preventive measures. Positive screenings were validated by a nursing-led delirium assessment team using the confusion assessment method. Process-related routine data screenings from 2023/2024 were evaluated descriptively. Results A delirium assessment team was established alongside a systematic delirium pathway focusing on risk identification, screening, prevention, confirmatory diagnosis, and treatment of deliriogenic causes. In the ENT clinic, 63 positive screenings were recorded in 2023/2024. The cumulative delirium incidence was 30.2% overall (men 32.0%, women 23.1%); age-stratified: 0% (< 65 years), 45.8% (65–79 years), and 27.6% (≥ 80 years). The new processes showed good acceptance. Conclusion Structured capture of positive screenings enables collection of robust routine data for quality management. Process breaks due to manual steps favor underdetection and treatment delays. Digitally automated process components can increase adherence and process stability. Artificial intelligence (AI)-based decision-support tools appear promising for future clinical use.

Der geriatrische Tumorpatient im Fokus des pflegerischen Delir-Managements

期刊论文
发表日期：

2026年3月30日

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Julius Schmidt

摘要

Background

Postoperative delirium is an acute, fluctuating neurocognitive syndrome. It is among the most common perioperative complications in older patients and is associated with increased morbidity and mortality, a prolonged length of stay, complications, and persistent cognitive impairment. After major head and neck procedures, the risk is particularly high; risk factors often accumulate, including advanced age, pre-existing cognitive impairment, high American Society of Anesthesiologists (ASA) status, polypharmacy, malnutrition, and prolonged operative time. No established pharmacological primary therapy exists; early detection, prevention, and treatment of underlying causes are first line.

Objective

This work constitutes the initial implementation and testing of a process-oriented delirium management program in the departments of otorhinolaryngology (ENT) and ophthalmology of a university hospital.

Methods

A practice development project was carried out (2022–2024) to implement standardized delirium management in ENT and ophthalmology. It included risk stratification upon admission, monitoring using the Delirium Observation Screening Scale, and non-pharmacological preventive measures. Positive screenings were validated by a nursing-led delirium assessment team using the confusion assessment method. Process-related routine data screenings from 2023/2024 were evaluated descriptively.

Results

A delirium assessment team was established alongside a systematic delirium pathway focusing on risk identification, screening, prevention, confirmatory diagnosis, and treatment of deliriogenic causes. In the ENT clinic, 63 positive screenings were recorded in 2023/2024. The cumulative delirium incidence was 30.2% overall (men 32.0%, women 23.1%); age-stratified: 0% (< 65 years), 45.8% (65–79 years), and 27.6% (≥ 80 years). The new processes showed good acceptance.

Conclusion

Structured capture of positive screenings enables collection of robust routine data for quality management. Process breaks due to manual steps favor underdetection and treatment delays. Digitally automated process components can increase adherence and process stability. Artificial intelligence (AI)-based decision-support tools appear promising for future clinical use.