The 2023 World delirium awareness and quality Survey: A Canadian substudy

Karla D Krewulak¹, Laurie A Lee², Kathryn Strayer¹, Jennifer Armstrong³, Nadia Baig⁴, Judith Brouillette⁵, Kirsten Deemer¹, Natalia Jaworska¹, Katherine A Kissel⁶, Christine MacDonald⁷, Tanya Mailhot⁸, Oleksa Rewa⁴, Eric Sy⁹, Peter Nydahl¹⁰, Rebecca von Haken¹¹, Heidi Lindroth¹², Keibun Liu¹³, Kirsten M Fiest¹⁴

Affiliations

¹ Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.
² Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada; Faculty of Nursing, University of Calgary, Calgary, AB, Canada; Pediatric Intensive Care Unit, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
³ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
⁴ Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.
⁵ Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montreal, Quebec, Canada.
⁶ Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada; Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
⁷ Department of Pediatrics, Alberta Health Services, Calgary, AB, Canada.
⁸ Montreal Heart Institute Research Center and Faculty of Nursing, University of Montreal, Montreal, Qc, Canada.
⁹ Department of Critical Care, Saskatchewan Health Authority, Regina, SK, Canada; Department of Medicine, College of Medicine, University of Saskatchewan, Regina, SK, Canada.
¹⁰ Nursing Research, University Hospital Schleswig-Holstein, Kiel, Germany; Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria.
¹¹ Department of Anesthesiology, University Hospital Mannheim, Mannheim, Germany.
¹² Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN, USA; Center for Aging Research, Regenstrief Institute, School of Medicine, Indiana University, Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, USA.
¹³ Non-Profit Organization ICU Collaboration Network (ICON), 2-15-13 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Department Intensive Care, Radboud University Medical Center, Nijmegen, the Netherlands.
¹⁴ Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. Electronic address: kmfiest@ucalgary.ca.

PMID: 40024089
DOI: 10.1016/j.iccn.2025.103980

Free article

The 2023 World delirium awareness and quality Survey: A Canadian substudy

Karla D Krewulak et al. Intensive Crit Care Nurs. 2025 Jun.

Free article

. 2025 Jun:88:103980.

doi: 10.1016/j.iccn.2025.103980. Epub 2025 Mar 1.

Authors

Affiliations

¹ Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.
² Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada; Faculty of Nursing, University of Calgary, Calgary, AB, Canada; Pediatric Intensive Care Unit, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
³ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
⁴ Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada.
⁵ Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montreal, Quebec, Canada.
⁶ Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada; Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
⁷ Department of Pediatrics, Alberta Health Services, Calgary, AB, Canada.
⁸ Montreal Heart Institute Research Center and Faculty of Nursing, University of Montreal, Montreal, Qc, Canada.
⁹ Department of Critical Care, Saskatchewan Health Authority, Regina, SK, Canada; Department of Medicine, College of Medicine, University of Saskatchewan, Regina, SK, Canada.
¹⁰ Nursing Research, University Hospital Schleswig-Holstein, Kiel, Germany; Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria.
¹¹ Department of Anesthesiology, University Hospital Mannheim, Mannheim, Germany.
¹² Division of Nursing Research, Department of Nursing, Mayo Clinic, Rochester, MN, USA; Center for Aging Research, Regenstrief Institute, School of Medicine, Indiana University, Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, USA.
¹³ Non-Profit Organization ICU Collaboration Network (ICON), 2-15-13 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Department Intensive Care, Radboud University Medical Center, Nijmegen, the Netherlands.
¹⁴ Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. Electronic address: kmfiest@ucalgary.ca.

PMID: 40024089
DOI: 10.1016/j.iccn.2025.103980

Abstract

Objective: This study aimed to evaluate the proportion of screened patients with delirium and the strategies used for its management in Canadian hospitals caring for critically ill children or adults.

Methods: This is a secondary analysis of a cross-sectional study completed on World Delirium Awareness Day (March 15, 2023). Respondents completed a 35-question survey on the proportion of screened patients with delirium (at 8:00 am and 8:00 pm), treatment, and management strategies employed.

Results: A total of 27 ICUs (22 adult and 5 pediatric) participated. Among adult ICU patients assessed for delirium, 18 % (n = 34/194) had delirium at 8:00 am and 18 % (32/181) had delirium at 8:00 pm. In pediatric ICUs, the proportion of screened patients with delirium was higher, with 50 % (n = 8/16) at 8:00 am and 44 % (n = 7/16) at 8:00 pm. Delirium management strategies varied: with non-pharmacological approaches such as multi-professional rounds (100 %), pain management (96 %), and mobilization (85 %) being most common. The most reported written delirium management protocols included spontaneous breathing trials in adult ICUs and physical restraint and sedation management in PICUs. Few ICUs reported written protocols for family engagement and empowerment.

Conclusions: Delirium remains a prevalent issue in Canadian ICUs, with variability in assessment and management strategies. Gaps in family engagement and pediatric-specific protocols persist. Addressing barriers like staff shortages and lack of training is critical to improving care.

Implications for clinical practice: Improving delirium management requires standardized protocols, especially in PICUs, and better integration of family engagement in care. Addressing workforce challenges (e.g., staff shortages and educating new staff on delirium) will be crucial for enhancing delirium prevention and treatment in Canadian ICUs. Further research should focus on pediatric-specific interventions and pharmacological management.

Keywords: Critical care; Delirium; Intensive care units; Intensive care units, pediatric; Protocols.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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The 2023 World delirium awareness and quality Survey: A Canadian substudy

Affiliations

The 2023 World delirium awareness and quality Survey: A Canadian substudy

Authors

Affiliations

Abstract

Conflict of interest statement

MeSH terms

LinkOut - more resources

Full Text Sources

Medical