[Implementation of delirium management in inpatient care: results from IQM peer reviews].

BACKGROUND: Delirium is a frequent neuropsychiatric disorder, particularly in older hospitalized and critically ill patients, which is associated with negative consequences such as increased mortality and morbidity. Due to the ageing population, an increase in delirium cases is to be expected, further increasing the need for standardized inpatient delirium care; however, the implementation of structured delirium management in an inpatient setting has not been sufficiently examined.

METHOD: As part of the Delirium Awareness Campaign launched by the Initiative on Quality in Medicine (Initiative Qualitätsmedizin, IQM) a retrospective, descriptive, multicenter analysis was carried out based on peer reviews. Case files from German and Swiss IQM member hospitals were retrospectively evaluated by medical and nursing professionals using a standardized questionnaire.

RESULTS: In this study 115 questionnaires from 8 peer reviews could be descriptively evaluated. In 90% of cases risk factors for delirium were present, in particular advanced age, surgical procedures and pre-existing cognitive disorders. In 26% of cases structured delirium screening was used, mostly once. Guideline-compliant diagnostics and treatment were determined by IQM peers in 13.9% of cases. Delirium was documented in the discharge letter in 19.1% of cases. In almost half of the cases (46.1%) a clear potential for improvement was identified during the course of inpatient treatment.

DISCUSSION: The IQM peer review revealed a relevant gap in the routine clinical inpatient treatment and underscored the need to structurally embed delirium management as an interprofessional and standardized care process.