Decreasing Early Postoperative Delirium in High-Risk Patients by Standardizing Re-Orientation in the Recovery Room

Background Bundled multicomponent interventions prevent postoperative delirium (POD), but their resource demands remain a challenge. Identifying simpler, effective strategies is essential. Network meta-analysis has identified reorientation as a key strategy for delirium prevention. Objective This quality improvement (QI) project assessed whether a standardized Post-Anesthesia Care Unit (PACU) reorientation protocol reduces early POD in high-risk older patients. Methods We compared POD incidence in high-risk patients before and after the implementation of a standardized reorientation protocol. POD screening included the 4 A’s test. Results Following implementation, PACU reorientation increased from an average of 0.6 to 1.4 times per PACU stay. Regression analysis showed that the odds of developing postoperative day 1 POD decreased by 25% with each passing month after PACU reorientation was standardized (adjusted OR 0.75; 95% CI 0.58–0.96; p = 0.02). Conclusion Standardized PACU reorientation was linked increased reorientations and reduced early POD in high-risk older patients.