Strategies and facilitating and hindering factors in the implementation of sustainable delirium management in acute care: a holistic multiple case study

Background Delirium is a common and serious complication in hospitalized patients. It is associated with prolonged hospital stays, increased treatment costs, stress for patients and their families, and challenges for the interprofessional care team. Multicomponent intervention strategies have been shown to improve delirium prevention and treatment. Despite their effectiveness, implementation is not always successful. Evidence suggests that strong management support and effective interprofessional collaboration facilitate adoption, whereas structural barriers and staffing challenges hinder the sustainable integration of delirium management practices. In German-speaking countries, research on strategies for sustainably implementing delirium management and the factors influencing its implementation remains limited. The aim of this study was to investigate and compare strategies and factors that facilitate or hinder sustainable delirium management in four hospitals in German-speaking countries. Methods Qualitative research was performed using a holistic multiple case study design. In October–December 2024, eight guided interviews were conducted with nurses and physicians from four hospitals in German-speaking countries. All participants were involved in delirium management at their respective institutions. The interviews were transcribed and analysed using Schreier’s eight steps of qualitative content analysis. Both within-case and cross-case analyses were conducted to enable cross-institutional comparison of the findings. Results The analyses identified a wide range of strategies for sustainable delirium management, including interprofessional collaboration; networking; a person-centred approach; training and learning formats; practical delirium guidelines; and integration of components such as delirium screening, orientation aids, and family involvement. Additional strategies included the use of specific roles, the availability of resources, and multi-year concept development accompanied by continuous refinement of key strategies. The most important facilitating factors were interprofessional collaboration, managerial support, growing expertise in the field of delirium, and long-term strategic priority. Hindering factors included limited acceptance of specialized nursing roles, work overload, knowledge gaps regarding delirium, structural barriers, and shortages of time and staff. Conclusion Sustainable delirium management relies on the interaction of multiple complementary strategies. Several facilitating and hindering factors can influence the sustainability of delirium management in acute care. The results underscore the need to establish delirium management in acute care as a long-term strategic priority supported by adequate resources.