Delirium on stroke units: a prospective, multicentric quality-improvement project

Area of Science:

• Neurology
• Geriatrics
• Quality Improvement

Background:

• Post-stroke delirium (POD) is linked to increased complications and poor outcomes in stroke unit (SU) patients.
• Implementing interprofessional delirium management aims to mitigate POD severity.

Purpose of the Study:

• To evaluate the effectiveness of an interprofessional delirium management program in reducing POD severity.
• To assess the impact of the intervention on POD incidence, duration, functional outcomes, and length of stay.

Main Methods:

• A multicentric quality improvement project using a pre/post-comparison design across five SUs.
• Primary outcome: POD severity (Nursing Delirium Screening Scale - Nu-DESC).
• Secondary outcomes: POD incidence, duration, modified Rankin Scale (mRS), length of stay, and mortality.

Main Results:

• Delirium management was implemented in 75% of delirious patients in the post-period.
• A non-significant reduction in POD severity was observed (Nu-DESC median: pre 3.5 vs. post 3.0, p=0.154).
• Patients with severe stroke and POD showed no improvement in disability levels compared to non-delirious patients.

Conclusions:

• Delirium management is feasible in SUs, with nursing interventions reaching most patients.
• The intervention showed limited effects on POD duration and length of stay.
• POD significantly hinders rehabilitation, especially in patients with severe strokes.