Morandi, Alessandro

Background Global efforts to raise delirium awareness have been made over the past years, such as the formation of the iDelirium group and the institution, in 2017, of the annual World Delirium Awareness Day (WDAD) in March. In 2023, our group and researchers from around the world conducted a global one-day point prevalence study of delirium on WDAD. These strategies appear to improve delirium recognition and management. Objective To assess participants’ perceived impact of participating in the WDAD 2023 one-day point prevalence study and to gather feedback on the survey process to inform future campaigns. Methods An online survey was administered to multiple national and clinical collaborators from 44 countries participating in the one-day global point delirium prevalence study on WDAD 2023. Using SurveyMonkey®, the survey was distributed via a snowball system, with participants’ consent implied through their involvement. The survey, developed iteratively to balance time and detail, consisted of six core questions, including closed and open formats. Data were collected from September 9th to October 9th, 2023, and qualitative and quantitative analyses were performed using Excel®. Quantitative data underwent statistical analysis using IBM® SPSS Statistics28. Results 49 out of 53 (93.45%) healthcare professionals responded to the survey: 71.43% reported increased awareness, and responses were almost equally divided between those who initiated projects (46.94%) and those who did not (53.06%). Most participants (93.88%) did not find the WDAD 2023 one-day point prevalence study in March burdensome, and all expressed interest in future participation. The WDAD 2023 one-day point prevalence study highlighted diverse projects, primarily focused on delirium awareness and education. The survey found suggestions for future improvements emphasizing more efficient, digital, and engaging research methods and a clear need for educational resources, particularly in ICU delirium. Conclusions Our survey finds that participation in WDAD 2023 one-day point prevalence study boosted delirium visibility, leading to ongoing awareness, interest in future studies, and practice changes that benefit patients and the healthcare system. Further evidence-based research is needed to assess the impact of these campaigns on delirium recognition and management.

Abstract Background Delirium, an acute brain dysfunction, is proposed to be highly prevalent in clinical care and shown to significantly increase the risk of mortality and dementia. Objectives To report on the global prevalence of clinically documented delirium and delirium-related clinical practices in wards caring for paediatric and adult patients in healthcare facilities. Design A prospective, cross-sectional, 39-question survey completed on World Delirium Awareness Day, 15 March 2023. Participants Clinicians or researchers with access to clinical data. Main Outcome and Measure The primary outcome was the prevalence of clinically documented delirium at 8:00 a.m. (4 h) and 8:00 p.m. (±4 h). Secondary outcomes included delirium-related care practices and barriers to use. Descriptive statistics were calculated and multilevel modelling was completed. Results 1664 wards submitted surveys from 44 countries, reporting on delirium assessments at 8:00 a.m. (n = 36 048) and 8:00 p.m. (n = 32 867); 61% reported use of validated delirium assessment tools. At 8:00 a.m., 18% (n = 2788/15 458) and at 8:00 p.m., 17.7% (n = 2454/13 860) were delirium positive. Top prevention measures were pain management (86.7%), mobilisation (81.4%) and adequate fluids (80.4%). Frequently reported pharmacologic interventions were benzodiazepines (52.7%) and haloperidol (46.2%). Top barriers included the shortage of staff (54.3%), lack of time to educate staff (48.6%) and missing knowledge about delirium (38%). Conclusion and Relevance In this study, approximately one out of five patients were reported as delirious. The reported high use of benzodiazepines needs further evaluation as it is not aligned with best-practice recommendations. Findings provide a benchmark for future quality improvement projects and research.

Abstract Background Delirium is a common complication of older people in hospitals, rehabilitation and long-term facilities. Objective To assess the worldwide use of validated delirium assessment tools and the presence of delirium management protocols. Design Secondary analysis of a worldwide one-day point prevalence study on World Delirium Awareness Day, 15 March 2023. Setting Cross-sectional online survey including hospitals, rehabilitation and long-term facilities. Methods Participating clinicians reported data on delirium, the presence of protocols, delirium assessments, delirium-awareness interventions, non-pharmacological and pharmacological interventions, and ward/unit-specific barriers. Results Data from 44 countries, 1664 wards/units and 36 048 patients were analysed. Validated delirium assessments were used in 66.7% (n = 1110) of wards/units, 18.6% (n = 310) used personal judgement or no assessment, and 10% (n = 166) used other assessment methods. A delirium management protocol was reported in 66.8% (n = 1094) of wards/units. The presence of protocols for delirium management varied across continents, ranging from 21.6% (on 21/97 wards/units) in Africa to 90.4% (235/260) in Australia, similar to the use of validated delirium assessments with 29.6% (29/98) in Africa to 93.5% (116/124) in North America. Wards/units with a delirium management protocol [n = 1094/1664, 66.8%] were more likely to use a validated delirium test than those without a protocol [odds ratio 6.97 (95% confidence interval 5.289–9.185)]. The presence of a delirium protocol increased the chances for valid delirium assessment and, likely, evidence-based interventions. Conclusion Wards/units that reported the presence of delirium management protocols had a higher probability of using validated delirium assessments tools to assess for delirium.

Delirium is common in hospitalised patients, and there is currently no specific treatment. Identifying and treating underlying somatic causes of delirium is the first priority once delirium is diagnosed. Several international guidelines provide clinicians with an evidence-based approach to screening, diagnosis and symptomatic treatment. However, current guidelines do not offer a structured approach to identification of underlying causes. A panel of 37 internationally recognised delirium experts from diverse medical backgrounds worked together in a modified Delphi approach via an online platform. Consensus was reached after five voting rounds. The final product of this project is a set of three delirium management algorithms (the Delirium Delphi Algorithms), one for ward patients, one for patients after cardiac surgery and one for patients in the intensive care unit.