Sana Kliniken Niederlausitz is a university-affiliated hospital in Germany, providing specialist care, 543 beds, and 1,200 employees. Before starting the project, no delirium management protocols or other pertinent service assessments existed.

The DIVI-certified IPE course for delirium management contains 20 teaching units, each 45 minutes long, on delirium with a focus on intensive care and emergency medicine.²⁶ It delivers essential knowledge on delirium, educates on delirium management strategies, and provides implementation recommendations based on a plan-do-check-act (PDCA) cycle. The curriculum is designed for interprofessional and interdisciplinary stakeholders. Providers decide on the exact educational approach, including case-based (e.g. case study discussions), reflective (e.g. discussing experiences and ideas from different perspectives), simulated (e.g. role plays) and problem-based (e.g. design and launch quality improvement projects) learning. The program is completed in two full working days with breaks and includes a four-hour evaluation meeting eight weeks later.

Implementation of delirium management is a complex process. Aspects such as the intervention itself, but also organisational culture (structures, processes, readiness and ability to change), local conditions (staff, laws, regulations), and clinicians (attitude, knowledge, competencies), including related barriers and facilitators need consideration.²⁸

At the end of the first two days, participants organised themselves into different groups and reflected on possibilities for optimising delirium management on their wards and units, identifying and assessing both barriers and facilitators. They then gave a short report and defined a feasible eight-weeks goal.

We evaluated participant ability to perform self-defined QI projects in their wards and units. Primary outcome was the number of successful projects at the eight-week evaluation meeting.

Due to the character of a service evaluation and improvement, no ethics approval was required.

Participants had several opportunities to interact and were motivated to change practice. They appreciated the interprofessional and interdisciplinary discussions and shared their perspectives and ideas. Finally, participants organised themselves into five groups. First, barriers were reflected, such as staff shortage or missing opportunities for documentation (organisational barriers), time pressure and low frequency of delirium assessment (local barriers), lack of knowledge about delirium or complaining attitude (clinicians’ barriers), and others (Table 1). Due to nurses, physicians, and therapists’ different views on the barriers, participants developed solutions for specific questions. Finally, they developed feasible ideas for SMART (specific, measurable, achievable, realistic, timely) projects.

Participants organised themselves into five different project groups:

During the concluding discussion on the third day, participants appraised the IPE course positively. They reported an improved knowledge and attitude towards delirium management. Participants were satisfied with the structure, process, content, and methods. They reported feeling more confident in providing care to patients with delirium and performing quality improvement projects in their hospital. Participants felt additional improvement in learning could be achieved through training in a simulation centre or with actors portraying delirious patients.

Most clinicians generally provided basic delirium prevention measures, such as vision- and hearing aids, calendar, or clock. But in the initial phase, delirium awareness and management were still variably implemented. There were differences within the departments and professional groups. Delirium screening was carried out irregularly on normal wards but regularly thrice daily on intensive care units. In the emergency room, the priority was on treatment of severe hyperactive delirium. On general wards, delirium superimposed on dementia was seen as a central challenge, and in intensive care units, appropriate pharmacological treatment was a core question. Consequences of positive assessments were different within departments and professions and might be related to interprofessional communication. While different needs required different solutions, participants benefitted from each other’s discussions and solutions. After the initial two days of IPE, they had increased awareness regarding delirium, tested the screening in their daily routine, searched for interprofessional communication, and acted as multipliers in their teams.

After the first training days, participants were asked for their experiences by their colleagues, and participants could use this interest to inform them about delirium, to raise their delirium awareness.

Participants also reported difficulties managing the differences between expectations and practice, e.g., correct delirium assessment, communication with other professions, missing structures, etc.

The interactive nature of the project prevented the collection of missing information related to interesting aspects.

Strengths of this work are: a) a structured, interactive QI project with clinicians from several wards/units across the hospital, using intrinsic motivation and expert knowledge across different disciplines and professions; b) the documentation of this project, enabling transparent reporting of each step; c) motivated hospital management who appreciated the funding and development of their delirium-specific QI group.

Limits to the generalisability of the work include: a) IPE-related limitations such as methods and measures, amount of interaction and time schedule, presentations, or personality which might have hampered individual learning progress in participants; nevertheless, participants’ feedback was most positive, and the limitation might be less relevant; b) the setting, culture and specific team-communication of a university-affiliated hospital in East Germany; results might be different in other settings and cultures; c) most reported projects included planning of projects only; nevertheless, we believe that establishing structures and processes is a fundamental step in hospital-wide projects and represent a project by itself; d) long-term sustainability of these projects have not been proven; hence, this success on patients, staff, economics, or even society cannot be reported, yet; contrary, the overall project just started and will be followed by the research team.

All authors FS, VH, UG, HCH, TD, RvH, CH, CHo, AK, SP, and PN made substantial contributions to the conception and design of the work; FS, VH, and PN have drafted the work; UG, HCH, TD, RvH, CH, CHo, AK, and SP substantively revised it; all authors FS, VH, UG, HCH, TD, RvH, CH, CHo, AK, SP, and PN approved the submitted version (and any substantially modified version that involves the author’s contribution to the study); all authors FS, VH, UG, HCH, TD, RvH, CH, CHo, AK, SP, and PN agreed to be personally accountable the accuracy and integrity of any part of the work.

The quality improvement project was performed in concordance with the declaration of Helsinki and Good Clinical Practice. Due to the character of a service evaluation and improvement, no ethic approval was required.

The authors report no conflicts related to this work.