Abstract
Delirium in geriatric intensive care unit (ICU) patients is associated with prolonged hospital stays, increased mortality, and persistent post-discharge cognitive decline. This pre-post intervention study evaluated the effectiveness of an Interprofessional Delirium Prevention Protocol (IDPP) on cognitive outcomes, delirium incidence, and clinical endpoints among critically ill older adults. The study included 240 patients aged 65 years and older admitted to an 18-bed medical-surgical ICU (120 pre-intervention historical controls receiving standard care; 120 post-intervention patients receiving the IDPP). The IDPP incorporated nurse-led daily sedation vacation, targeted pharmacist medication optimization, early physical mobilization, sensory restoration, and a structured night-time sleep bundle. Primary outcomes were delirium incidence evaluated via the Confusion Assessment Method for the ICU (CAM-ICU) and delirium duration. Secondary outcomes included ICU length of stay and cognitive function at 30 days post-discharge using the Telephone Interview for Cognitive Status (TICS). Following protocol implementation, delirium incidence decreased significantly from 48.3% (n=58) to 26.7% (n=32) (p < 0.001). Mean delirium duration decreased from 4.2 ± 1.8 days to 2.1 ± 1.1 days (p < 0.001). Median ICU length of stay was reduced from 7.5 to 5.2 days (p = 0.004). At 30 days post-discharge, patients in the intervention cohort demonstrated significantly higher TICS cognitive scores compared to control patients (32.4 ± 3.8 vs. 28.1 ± 4.5, p = 0.002). Integrating an interprofessional, nurse-driven delirium prevention bundle substantially reduces delirium burden and improves short-term cognitive recovery in geriatric critical care patients.
