Department of Orthopaedics and Trauma Surgery, Flinders University and Flinders Medical Centre, Adelaide, SA 5042, Australia.
Department of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders University, Flinders Drive Bedford Park, SA 5042, Australia.
Int J Qual Health Care. 2021 Feb 20;33(1). doi: 10.1093/intqhc/mzab006.
Delirium is commonly detected in older people after hip fracture. Delirium is considered to be a multifactorial disorder that is often seen post-operatively (incidence ranging from 35% to 65%). Hospitals in Australia are required to meet eight standards including the comprehensive care standard to be able to maintain their accreditation. The standard includes actions related to falls, pressure injuries, nutrition, mental health, cognitive impairment and end-of-life care. Delirium prevention was identified as an area for improvement in our Orthopaedic unit in a Level 1 University Trauma Centre in Australia. This implementation research project aimed to understand the efficacy of a delirium prevention intervention within an existing orthopaedic speciality care system.
Implementation of the tailored intervention will increase adherence to National Safety and Quality Health Service Standards, thereby reducing rate of delirium.
In this study, we used an interrupted time series design to examine changes in practice over time in people admitted to hospital with a hip fracture. Clinical staff caring for patients with hip fracture in an acute care setting in Adelaide, South Australia, participated in the project. In brief, intervention included education, environmental restructuring, change champions, infographics and audit feedback reports. The primary outcome of interest was rate of delirium. The secondary outcome was compliance with the use of delirium 4AT screening tool, duration of delirium and hospital length of stay.
The rate of change per month in patients with delirium decreased significantly by 19.2%. There was no significant change observed in trend for duration of delirium and length of hospital stay between pre-intervention and post-intervention phases. A significant increase in the use of screening tool was observed from 4.7% in the pre-intervention phase to 33.6% in the post-intervention phase.
Translation of evidence-based intervention model incorporating well-considered implementation strategies had a mixed impact on decreasing the rate of delirium. The scheduled hospital accreditation enhanced the use of validated screening tool to recognize delirium. This project highlights the importance of aligning implementation goals with the wider goals of the organization as well as making clinicians accountable by consistent auditing.
髋部骨折后，老年人中常出现谵妄。谵妄被认为是一种多因素疾病，术后常见（发生率为 35%至 65%）。澳大利亚的医院需要满足八项标准，包括综合护理标准，才能保持其认证。该标准包括与跌倒、压疮、营养、心理健康、认知障碍和临终关怀相关的措施。在澳大利亚一家一级大学创伤中心的骨科病房，我们发现预防谵妄是一个需要改进的领域。这项实施研究项目旨在了解在现有的骨科专科护理系统中实施预防谵妄干预的效果。
实施定制干预措施将提高对国家安全和质量卫生服务标准的遵守率，从而降低谵妄发生率。
在这项研究中，我们使用中断时间序列设计来检查在南澳大利亚阿德莱德的一家急性护理医院接受髋部骨折治疗的患者的实践随时间的变化。参与该项目的是在急性护理环境中照顾髋部骨折患者的临床工作人员。简而言之，干预措施包括教育、环境重构、变革拥护者、信息图表和审计反馈报告。主要观察指标是谵妄发生率。次要观察指标是使用谵妄 4AT 筛查工具的依从性、谵妄持续时间和住院时间。
谵妄患者每月的变化率显著下降 19.2%。在干预前后阶段，谵妄持续时间和住院时间的趋势均未观察到显著变化。在干预前阶段，筛查工具的使用率为 4.7%，而在干预后阶段则显著增加到 33.6%。
将基于证据的干预模式与经过深思熟虑的实施策略相结合的翻译，对降低谵妄发生率产生了混合影响。定期的医院认证增强了使用经过验证的筛查工具来识别谵妄的意识。该项目强调了将实施目标与组织的更广泛目标保持一致的重要性，以及通过持续审计使临床医生承担责任的重要性。
