Burden of Delirium, Sedation, and Pain Discussion and Decision Making on ICU Providers

Background Delirium is a common and morbid complication of critical illness, particularly among mechanically ventilated patients. Although sedation practices are a known modifiable risk factor for delirium, little is known about how frequently delirium and sedation are discussed during interdisciplinary ICU rounds or the proportion of rounding time devoted to these topics. Methods We conducted an observational manifest content analysis study of ICU rounding practices in a 30-bed medical intensive care unit at a tertiary academic medical center. Morning and afternoon ICU rounds were audio recorded over a five-week period. Recordings were transcribed and analyzed using quantitative and qualitative methods to measure the duration and proportion of time spent discussing delirium, sedation, and pain. The primary outcome was the proportion of time per patient encounter devoted to delirium and/or sedation discussions. Results A total of 184 recordings were included. The median patient age was 63 years (IQR 50–69), 86 patients (47%) were female, and 45 (24.7%) were mechanically ventilated. Median total rounding time per patient was 541 sec (IQR 365-800 sec) increasing to 738 sec (IQR 494-982 sec) for mechanically ventilated patients. Delirium discussions averaged 3 sec per patients (IQR 0-15 sec; 0.62% of rounding time) and increased to 10 sec (IQR 0-50 sec) among mechanically ventilated patients. Pain discussions averaged 0 sec per patient (IQR 0-5.5 sec). Sedation discussions averaged 0 secs (IQR 0-8.25 sec) overall and 34 sec (IQR 7-84 sec; 6.96% of total rounding time) among mechanically ventilated patients. Conclusions Despite the high prevalence and clinical impact of delirium in critically ill patients, delirium accounted for a limited proportion of interdisciplinary ICU rounding discussions, even among mechanically ventilated patients. Sedation received greater attention during rounds, highlighting the central role of sedation management in critical care workflows. These findings suggest an opportunity to better integrate structured delirium-focused discussions into ICU rounds to support consistent recognition and management.