出版社：Utrecht University, Maastricht University, Groningen University
摘要：Background : Postoperative cognitive dysfunction (POCD) appears in up to 30% of patients suffering from postoperative delirium (POD). Both are associated with higher mortality and postoperative complications, prolonged hospital stays, and increased costs. Multi-modal admission models with pre-admission risk reduction counselling ("prehabilitation"), perioperative monitoring and training of multidisciplinary patient care providers have been shown to decrease prevalence of both. The aim of our sub-study is to describe the current practice of risk communication and information flow between involved carers for patients at risk for PO(C)D, with the goal to develop optimized patient pathways. Method : This study is part of a multicenter study in German tertiary care hospitals, evaluating a complex intervention to reduce POCD after elective surgery for patients above 70 (Patient safety, cost effectiveness and quality of life: reduction of delirium risk and postoperative cognitive dysfunction after elective procedures in older adults. A stepped wedge cluster randomized trial (PAWEL, funded by innovation fund, project number 01VSF16016, DRKS00013311)). In order to capture present care pathways, we use focus group (FG) discussions with nurses and physicians from hospital departments (surgery, anesthesiology, orthopedics) and general practitioners (GPs ) in private practice. Group discussions follow a standardized scheme. Transcribed discussions are analyzed using qualitative content analysis. Preliminary Results : In the discussions performed yet, it became evident, that POCD is present above all in the daily work of nurses, whereas physicians (and especially GPs) seem to not perceive it as a relevant problem in their daily practice. Information about POD is often lost among other information in discharge letters. So if at all, GPs are mostly informed by relatives. Therefore there is also no regular risk assessment or communication performed prior to or after elective surgery. Nurses complaint that information about PO(C)D often gets lost during transfers between wards, and that they have no access to information given by the GP pre-operatively, required to adapt care to prevailing routines. Nurses underlined the importance of structures to achieve quietness and orientation. Relatives’ support was considered crucial. GPs asked for firmer communication of POD, so they might become more observant. However, they doubted the potential of pre-OP adjustment of medication like anticholinergic drugs. Discussion : Initially it was intended to involve GPs in adaption of pre-op medication. During the recruitment of the FG-participants it became clear, that German physicians (both in hospitals and GPs) often are unaware of POCD and potential tools to manage it, whereas nurses feel delirium is a condition of high significance. Conclusions : Awareness and transsectoral communication about risk factors and therapeutic options for these patients should be improved in all medical professions. Lessons learnt : Qualitative assessments of professionals’ perceptions are indispensable for adjusting care in a patient-centered way. Limitations : These preliminary results will be completed with additional FGs. Future research: should focus on implementation studies of proven preventive interventions.
关键词：interesctoral care ; elderly ; risk communication ; post-operative cognitive dysfunction
