BMJ Open (Mar 2023)

Quality contract ‘prevention of postoperative delirium in the care of elderly patients’ study protocol: a non-randomised, pre–post, monocentric, prospective trial

  • Sascha Treskatsch,
  • Claudia Spies,
  • Sophie K Piper,
  • Jochen Kruppa,
  • Felix Balzer,
  • Ursula Marschall,
  • Kathrin Scholtz,
  • Dieter Schmidt,
  • Joern Kiselev,
  • Moritz Höft,
  • Fatima Yürek,
  • Julian-Dominic Zimmermann,
  • Elisa Weidner,
  • Armin Hauß,
  • Enrico Dähnert,
  • Daniel Hadzidiakos,
  • Natia Sichinava,
  • Oscar Andrés Retana Romero,
  • Laerson Hoff,
  • Rudolf Mörgeli,
  • Lennart Junge,
  • Luzie Grüner,
  • Antonia Eva Maria Harborth,
  • Lisa Eymold,
  • Tuba Gülmez,
  • Elke Falk,
  • Franziska Landgraf,
  • Andreas Hölscher,
  • Mani Rafii

DOI
https://doi.org/10.1136/bmjopen-2022-066709
Journal volume & issue
Vol. 13, no. 3

Abstract

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Introduction Postoperative delirium (POD) is seen in approximately 15% of elderly patients and is related to poorer outcomes. In 2017, the Federal Joint Committee (Gemeinsamer Bundesausschuss) introduced a ‘quality contract’ (QC) as a new instrument to improve healthcare in Germany. One of the four areas for improvement of in-patient care is the ‘Prevention of POD in the care of elderly patients’ (QC-POD), as a means to reduce the risk of developing POD and its complications.The Institute for Quality Assurance and Transparency in Health Care identified gaps in the in-patient care of elderly patients related to the prevention, screening and treatment of POD, as required by consensus-based and evidence-based delirium guidelines. This paper introduces the QC-POD protocol, which aims to implement these guidelines into the clinical routine. There is an urgent need for well-structured, standardised and interdisciplinary pathways that enable the reliable screening and treatment of POD. Along with effective preventive measures, these concepts have a considerable potential to improve the care of elderly patients.Methods and analysis The QC-POD study is a non-randomised, pre–post, monocentric, prospective trial with an interventional concept following a baseline control period. The QC-POD trial was initiated on 1 April 2020 between Charité-Universitätsmedizin Berlin and the German health insurance company BARMER and will end on 30 June 2023. Inclusion criteria: patients 70 years of age or older that are scheduled for a surgical procedure requiring anaesthesia and insurance with the QC partner (BARMER). Exclusion criteria included patients with a language barrier, moribund patients and those unwilling or unable to provide informed consent. The QC-POD protocol provides perioperative intervention at least two times per day, with delirium screening and non-pharmacological preventive measures.Ethics and dissemination This protocol was approved by the ethics committee of the Charité-Universitätsmedizin, Berlin, Germany (EA1/054/20). The results will be published in a peer-reviewed scientific journal and presented at national and international conferences.Trial registration number NCT04355195.