Developing a strategy to identify and treat older patients with postoperative delirium

AORN J. 2014 Feb;99(2):257-73; quiz 274-6. doi: 10.1016/j.aorn.2013.12.009.


Postoperative delirium is one of the most common adverse outcomes in elderly patients undergoing surgery and is associated with increased morbidity, length of stay, and patient care costs. The purpose of this quality improvement project was to evaluate the effectiveness of a multicomponent strategy to identify and treat general surgical patients 65 years of age or older at risk for and who develop postoperative delirium at Cape Cod Hospital, a community hospital in southern New England. We evaluated 96 patients using the Mini-Cog assessment tool preoperatively and the Confusion Assessment Method (CAM) delirium screening tool or CAM-Intensive Care Unit (CAM-ICU) assessment tool postoperatively. Patients who tested positive during preoperative assessment underwent a postoperative delirium management protocol. We summarized data using descriptive statistics. The results showed an association between compliance and outcomes. High compliance with implementation of CAM and CAM-ICU assessment tools resulted in increased identification of postoperative delirium in the older surgical population. The use of screening tools helped facilitate early identification of postoperative delirium in elderly surgical patients.

Keywords: CAM; CAM-ICU; CAM-Intensive Care Unit; Mini-Cog assessment; RASS; Richmond Agitation and Sedation Scale; assessment tools; cognitive assessment method; delirium; delirium screening tools; postoperative assessment; postoperative delirium.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Delirium / complications
  • Delirium / diagnosis*
  • Delirium / therapy*
  • Education, Continuing
  • Female
  • Guideline Adherence
  • Humans
  • Male
  • Massachusetts
  • Postoperative Complications*
  • Risk Factors
  • Societies, Nursing