Johns Hopkins University School of Medicine
According to estimates, 50% of older adults will have an operation after the age of 65 with postoperative delirium being the most common complication in this age group. Even though delirium is common, the diagnosis is often overlooked and improperly treated. The American Geriatric Society surveyed surgical specialists and found that delirium was the geriatric clinical issue having the largest knowledge gap. Most surgical training programs still have little geriatric care incorporated explicitly into the curricula, and little explicit assessment of skills in caring for older patients. There is still a significant gap in formalized delirium education in surgical training programs. Our goal is to address this gap with this postoperative delirium curriculum for general surgery residents. Our objective is that through this geriatric surgical curriculum with a foundation consisting of delirium prevention, assessment, and management will ultimately lead to improved surgical care outcomes for older adults. This is a case based guide to compliment an online module through the Surgical Council of Resident Education (SCORE) website. We designed an online module on the SCORE website on postoperative delirium and this is an interactive case based small group exercise along with pre-post test, mini-cex, pocket card, and consultant check sheet. The case will require learners to go through a real surgical case, identify and modify risk factors, do delirium risk assessment, use a validated delirium screening tool (4AT), and come up with prevention and treatment options.
After completion of the curriculum, the surgical resident will be able to:
- Identify the pathophysiological causes of postoperative delirium.
- Identify risk factors for the development of postoperative delirium.
- Recognize interventions to prevent postoperative delirium.
- Describe the common presentation of delirium and be able to distinguish delirium from dementia and depression.
- Recognize evidence based assessment tools (e.g. 3D CAM, 4AT, etc.) as reliable ways to screen for postoperative delirium.
- Describe the major effects that delirium has on surgical and patient outcomes.
- Correctly employed a validated delirium assessment tool (e.g. 4AT) to screen postoperative delirium in non-ICU older confused surgical patient.
- Calculate the correct delirium risk assessment score for a case scenario.
- Propose strategies for mitigating preoperative, intraoperative, and postoperative risk factors for a common general surgery case scenario.
- Identify "best-practice" non-pharmacologic and pharmacologic treatment strategies to manage postoperative delirium given a case scenario
- Demonstrate to their attending or geriatric consultant the correct use of a validated delirium assessment tool to screen for postoperative delirium in non-ICU older confused surgical patient.
- Perform prevention measures and monitor delirium development via evidence based assessment method (e.g 4AT) prior to geriatric consult.
As a result of the curriculum, surgical residents will rate as important that surgeons should know:
1. Treatment strategies for postoperative delirium.
2. How to screen for postoperative delirium using a validated assessment tool.
3. Strategies to prevent postoperative delirium.