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Randomized Controlled Trial
. 2025 Oct 1;37(4):361-370.
doi: 10.1097/ANA.0000000000001016. Epub 2024 Dec 19.

Feasibility of Alerting Systems and Family Care Partner Support for Postoperative Delirium Prevention

Phillip E Vlisides  1   2 , Nathan Runstadler  1 , Selena Martinez  1 , Jacqueline W Ragheb  3 , Graciela Mentz  1 , Aleda Leis  4 , Amanda Schoettinger  5 , Kimberly Hickey  6 , Amy McKinney  1 , Joseph Brooks  7 , Mackenzie Zierau  8 , Alexandra Norcott  9   9 , Lona Mody  9 , Sharon K Inouye  10   11 , Michael S Avidan  12 , Lillian Min  9   13
Affiliations
Randomized Controlled Trial

Feasibility of Alerting Systems and Family Care Partner Support for Postoperative Delirium Prevention

Phillip E Vlisides et al. J Neurosurg Anesthesiol. .

Abstract

Background: The objective of this study was to determine whether postoperative pager alerts to the Hospital Elder Life Program (HELP), a delirium prevention service, would accelerate program enrollment for older surgical patients. This study also tested feasibility of family care partner interventions for delirium prevention.

Methods: This single-center, pilot clinical trial factorially randomized 57 non-cardiac surgical patients ≥70 years of age to 4 arms: (1) standard care, (2) pager alerts to accelerate HELP enrollment, (3) family care partner-based delirium prevention interventions, or (4) a combined arm with both HELP and family interventions. The primary clinical outcome was delirium (assessed through the Confusion Assessment Method).

Results: In the pager alerting arms, 13/24 (54%) participants were enrolled by HELP on postoperative day 1 compared with 0/26 (0%, P <0.001) in the non-alerting arms. Median [interquartile range] time spent in delirium prevention protocols was significantly longer in pager alerting arms than in non-alerting arms (39 [5 to 75] min vs. 0 [0 to 0] min; P <0.001). Family care partners spent 18 [11 to 25)] hours at the bedside over the first 3 postoperative days. There was no significant difference in delirium occurrence in participants randomized to pager alert arms compared with non-alerting arms (odds ratio, 1.02, 95% CI, 0.97-1.07; P =0.390). Similarly, there was no significant difference in delirium occurrence in family intervention arms compared with nonintervention arms (odds ratio, 0.97; 95% CI 0.93-10.02; P =0.270).

Conclusions: Pager alerts significantly reduced time to HELP enrollment, albeit without reducing delirium incidence in this pilot study. Family care partners spent substantial time at the bedside during the study period.

Trial registration: ClinicalTrials.gov NCT04007523.

Keywords: clinical decision support systems; clinical trial; delirium; feasibility studies; health services for the aged.

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Conflict of interest statement

P.E.V., A.M., and L.M. receive support from Blue Cross Blue Shield of Michigan (Detroit, MI) for quality improvement initiatives related to delirium. P.E.V. is a member of the Editorial Board of the Journal of Neurosurgical Anesthesiology. The remaining authors have no conflicts of interest to declare.

References

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