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| Name | Class |
|---|---|
| BARMER | OTHER |
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The project "QV-POD-2" is a prolongation based on "QV-POD-1", which was a quality contract program of the IQTIG - Institute for Quality and Transparency in Health Care. The aim is to improve inpatient care for older patients who are undergoing inpatient surgery and thus to specifically reduce the postoperative risk of delirium. This is achieved through the implementation of evidence-based and consensus-based measures to prevent postoperative delirium in a comprehensive structured concept in routine care. The transparent documentation in an electronic patient file enables the relationships between the symptoms to be depicted in accordance with the clinical circumstances and the genesis of the postoperative delirium to be recorded and treated at an early stage. The content of the additional elements from the routine data (see primary and secondary outcome measures) in QV-POD-2 is analysed internally.
Subproject Retro-Pressure started in August 2022:
Retrospective, exploratory cohort study using electronic anesthesia and hospital records from Jan 1, 2016 to Jan 1, 2020, including patients ≥70 years undergoing surgery with anesthesia. The objective is to quantify associations between intraoperative blood pressure dynamics-variability, rate of change, relative hypo-/hypertension versus baseline, and time-integrated BP (area under/above reference)-and postoperative organ dysfunction Primary endpoints: Emergence delirium incidence (PACU/ITS) based on Nu-DESC scores and CAM-ICU scores; incidence of postoperative acute renal failure (creatinine and urea levels, as well as urine output); intraoperative blood pressure variation*; intraoperative blood pressure variation rate*; intraoperative blood pressure integral* Secondary endpoints: Blood count (hemoglobin and hematocrit values); intraoperative transfusions of blood reserves Addendum from the ethics amendment vote of 25/07/2022
Subproject Delta-Scan started in August 2022:
Evaluation of brain function using "Delta Scan" Primary objective: Evaluation of the prognostic significance of Delta Scan measurements in relation to postoperative delirium Secondary objectives: Examination of the delirium-related predictive relevance of individual influencing factors (directly but also indirectly through Delta Scan values) and examination of the effect of Delta Scan measurements on standard delirium screening methods. Study and control group's Inclusion criteria: Age >= 70 years and major surgery with anesthesia; additional exclusion criterion in the control group: Inclusion in the QV-POD-1 project (receipt of postoperative preventive measures) Addendum from the ethics amendment vote of 25/07/2022
Subproject started in June,18th, 2026:
For selected patients who are scheduled to undergo a procedure in June, July or August 2026 as part of the QV-POD-2 study, a wristband called CardioWatch 287-2 (manufacturer: Corsano Health B.V., Wilhelmina van Pruisenweg 35, 2595 AN The Hague, The Netherlands, loaned by Medtronic, will be etsablished. For same-day surgery patients, monitoring begins before the operation and continues until discharge from the hospital. For pre-hospitalized patients, measurements can begin at least one day before surgery upon request. The recorded values include blood pressure, heart rate, heart rate variability, respiratory rate, oxygen saturation, body temperature, physical activity, and an electrocardiogram once a day.
The quality contract of the Charité Universitätsmedizin Berlin QV-POD was contractually extended so that the patients of the Charité Universitätsmedizin Berlin can be offered the preventive measures for delirium for another 5 years (07/01/2023 - 06/30/2028). The continuation of the contract is referred to with the short title QV-POD-2. In terms of content, all preventive measures known from QV-POD will be continued.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Cohort before training | 500 patients should be asked to participate in the project in the phase of zero value measurement. The documentation of the routine data before the training phase relates to patients aged ≥70 years, male and female, who are undergoing surgery. | ||
| Cohort after training 1 | From October 1st, 2020, the documentation of the routine data will begin after the training phase: 2,500 patients in 12 months, each aged ≥70 years, male and female, who will have surgery until the end of the contract on June 30th, 2023. | ||
| Cohort after documentation of routine data until June 2023 | From July 1st, 2023, the documentation of the routine data will go on: 1,700 patients in 12 months, each aged ≥70 years, male and female, who will have surgery until the end of the contract on June 30th, 2028. |
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| Measure | Description | Time Frame |
|---|---|---|
| Sustainability of implementation rates | QV-POD-2: Sustainability of implementation rates (=Number of patients who underwent delirium screening at least twice a day within the first three days postoperatively / Divisor = All recruited patients) of at least 80% for screening and documentation in the next five years. | Up to 5 years |
| Implementation rates | QV-POD-1: Implementation rates (=Number of patients who underwent delirium screening at least twice a day within the first three days postoperatively / Divisor = All recruited patients) of at least 60% for screening and documentation in the first year, at least 70% in the second year and at least 80% in the third year. Addendum to the primary outcome measures from the ethics amendment vote of 25/07/2022) | Up to 3 years |
| Measure | Description | Time Frame |
|---|---|---|
| Sustainability of implementation rates | QV-POD-2: Sustainability of implementation rates (=Number of patients who underwent delirium screening at least twice a day within the first five days postoperatively / Divisor = All recruited patients) of at least 80% for screening and documentation in the next five years | Up to 5 years |
| Measure | Description | Time Frame |
|---|---|---|
| Preoperative routine data | Preoperative routine data are medical history, diagnoses, medication, etc. | At baseline |
| Patient-specific characteristics | Patient-specific characteristics of patients with delirium |
Inclusion criteria:
Exclusion criteria:
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Patients aged ≥70 years, male and female, who are receiving surgery
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Claudia Spies, MD, Prof. | Contact | +49 30 450 55 11 02 | claudia.spies@charite.de |
| Name | Affiliation | Role |
|---|---|---|
| Claudia Spies, MD, Prof. | Charite University, Berlin, Germany | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Anesthesiology and Intensive Care Medicine (CBF), Charité - Universitätsmedizin Berlin | Recruiting | Berlin | 12203 | Germany |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36878649 | Derived | Yurek F, Zimmermann JD, Weidner E, Hauss A, Dahnert E, Hadzidiakos D, Kruppa J, Kiselev J, Sichinava N, Retana Romero OA, Hoff L, Morgeli R, Junge L, Scholtz K, Piper SK, Gruner L, Harborth AEM, Eymold L, Gulmez T, Falk E, Balzer F, Treskatsch S, Hoft M, Schmidt D, Landgraf F, Marschall U, Holscher A, Rafii M, Spies C. Quality contract 'prevention of postoperative delirium in the care of elderly patients' study protocol: a non-randomised, pre-post, monocentric, prospective trial. BMJ Open. 2023 Mar 6;13(3):e066709. doi: 10.1136/bmjopen-2022-066709. |
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| Implementation rates |
QV-POD-1: Implementation rates (=Number of patients who underwent delirium screening at least twice a day within the first five days postoperatively / Divisor = All recruited patients) of at least 60% for screening and documentation in the first year, at least 70% in the second year and at least 80% in the third year. Addendum to the secondary outcome measures from the ethics amendment vote of 25/07/2022) |
| Up to 5 years |
| Care level | The care level is taken from hospital records preoperatively and postoperatively | Up to one year |
| Routine laboratory | Routine laboratory markers | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Routine vital parameters | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Measurement of cholinesterases | Cholinesterases (point of care testing (POCT) measurements) are measured in the routine | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Intraoperative routine data | Time of surgery |
| Postoperative routine data on the ICU, in the recovery room and normal ward | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Drug administration during inpatient treatment | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Routine preventive measures against delirium | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Intraoperative documented peculiarities in patients with delirium | Time of surgery |
| Anticholinergic drug intake | Scale to identify the severity of anticholinergic drugs (Level 0 = no anticholinergic effect, Level 1 = mild anticholinergic effect, Level 2 = moderate anticholinergic effect, Level 3 = severe anticholinergic effect). The sum of all levels of the different drugs gives the total load. Higher total loads of anticholinergic drugs are associated with higher anticholinergic drug load. Minimum of the scale is 0. Maximum depends on the sum of each drug level. The more drugs with anticholinergic effect are taken the higher is the anticholinergic drug load. | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Duration of postoperative delirium | Duration of postoperative delirium in all postoperative patients in normal ward, intensive care unit and recovery room is measured in days (a defined day before the start of the training measures, a defined day after the completion of the training measures). Addendum to the secondary outcome measures from the ethics amendment vote of 25/07/2022) | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Incidence of postoperative delirium | Incidence of postoperative delirium in all postoperative patients in normal ward, intensive care unit and recovery room after validated delirium screening tool at two points in time (a defined day before the start of the training measures, a defined day after the completion of the training measures). | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Electroencephalography (EEG) measurement | Objective non-invasive EEG is measured intraoperatively | During the duration of surgery, an expected average of 2 hours |
| Infections | Infections according to surgical site infections (SSI) and according to the US Centers for Disease Control and Preventions (CDC). | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Quality of life 1 | Health related quality of life is measured by EQ-5D-5L | Up to one year (18 months) |
| Post Intensive Care Syndrome (PICS) | The composite outcome measure "PICS" of the patient is measured according to Needham et al 2012: New or worsening physical, cognitive, and/or mental impairments that are collectively called PICS measured by Patient Health Questionnaires (PHQ-4), MiniCog, Animal Naming Test Timed Up-and-Go (TUG), Handgrip strength. The measurements will be performed, when patients present to the outpatient clinic for follow-up examinations. | Up to one year |
| Postoperative complications | To evaluate the presence or development of postoperative organ complications during inpatient care | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Analgesia consumption | Concomitant pain medication is recorded | Up to one year |
| Postoperative cognitive impairment | Telephone or Video or questionnaire Follow up is offered to every patient with POD three months and one year after their surgery intervention. The aim of Telephone or Video or questionnaire Follow up is to assess to present Neurocognitive disorder (NCD).The Follow up screening tool is based on DSM 5 diagnostic criteria for "mild cognitive disorder". If one of the diagnostic criteria applies, we recommend to visit a neuropsychologist/ memory clinic recommend to visit a neuropsychologist/ memory clinic. | Up to three months |
| Depression | Depression is measured by Patient Health Questionnaire-8 (PHQ-8).This scale encompasses eight questions, which can be answered with not at all (0), several days (1), more than half the days (2) and nearly every day (3). The score is the sum of the 8 items. The minimum score is 0 (best outcome) and the heights 24 (worse outcome). | Up to one year |
| Anxiety | Anxiety is measured by Generalized Anxiety Disorder Scale-7 (GAD-7).The Assessment method has seven items; each can be answered with not at all (0), several days (1), more than half the days (2) and nearly every day (3). The score is the sum of all items. The minimum and maximum score are 0 (better outcome) and 21 (worse outcome) respectively. | Up to one year |
| Physical function | Physical health is measured by the sum scores of the following outcome measurement instruments: Timed Up-and-Go (TUG), Handgrip Strength, 2-Minute Walk Test (2-MWT), Short Physical Performance Battery (SPPB). | Up to one year |
| Intensive care unit length of stay | Intensive care unit length of stay is measured in days | Participants will be followed for the duration of intensive care stay, an expected average of 2 days |
| Hospital length of stay | Hospital length of stay is measured in days | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Pain levels 1 | Pain levels 1 are measured with Numeric Rating Scale (NRS). NRS scale's range from 0 to 10. 0: no pain; 1-3: light pain; 4-6: moderate pain; 7-10: severe pain. | Up to one year |
| Pain levels 2 | Pain levels 2 are measured with Visual Analog Scale (VAS). VAS scale's range from 0 to 10. 0: no pain; 1-3: light pain; 4-6: moderate pain; 7-10: severe pain. | Up to one year |
| Pain levels 3 | Pain levels 3 are measured with Assessment of pain in dementia (BESD). BESD: The focus of external observation is on the following behavioral patterns: breathing, negative vocalization, facial expression, body language, and comfort in relation to exertional pain. Observed behaviors are assigned a score from 0 to 2. The range of the score is between 0 and 10, with 10 points indicating the most pronounced pain behavior. | Up to one year |
| Pain levels 4 | Pain levels 4 are measured through the use of a scale based on behaviour items, the Behavioural Pain Scale (BPS). BPS scale's range from 3 to 12; 3: no pain, high number more pain. | Up to one year |
| Pain levels 5 | Pain levels 5 are measured through the use of a scale based on behaviour items, the Behavioural Pain Scale - non-intubated (BPS-NI). BPS-NI scale's range from 3 to 12; 3: no pain, high number more pain. In the BPS-NI, the BPS item "Adaptation to the Ventilator" has been replaced by "Vocalization." The BPS-NI can be used, for example, to determine pain status in conscious, delirious patients. | Up to one year |
| Disability 1 | Disability 1 is measured by Instrumental activities of daily living scale.This scale has 8 categories (ability to use telephone, shopping, food preparation, housekeeping, laundry, mode of transportation, responsibility for own medications, ability to handle finances). Each has different levels of functioning with a score assigned. The patient circles the item that most closely describes its functional level. The lowest score is 0 (better outcome) and the highest is 8 (worse outcome). | Up to one year |
| Disability 2 | Disability 2 is measured by Timed up and go test. | Up to one year |
| Disability 3 | Disability 3 is measured by hand grip strength test | Up to one year |
| Anxiety-Score | Faces Anxiety Scale score | Up to one year |
| Sedation | Sedation is measured with the Richmond Agitation and Sedation Scale (RASS) | Up to one year |
| Person's level of consciousness | The Glasgow Coma Scale (GCS) is a clinical scale used to reliably measure a person's level of consciousness after a brain injury. The GCS assesses a person based on their ability to perform eye movements, speak, and move their body. These three behaviors make up the three elements of the scale: eye, verbal, and motor. A person's GCS score can range from 3 (completely unresponsive) to 15 (responsive). This score is used to guide immediate medical care after a brain injury (such as a car accident) and also to monitor hospitalized patients and track their level of consciousness. Lower GCS scores are correlated with higher risk of death. | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Permanent medication | Medication at three months compared to baseline is assessed. | Up to one year |
| Frailty status | Frequency of frailty is measured by modified Fried criteria (category 1 +2 = pre-frail, category 3 -5 = frail) | Up to one year |
| Postoperative oral ingestion | Ingestion is measured by the amount of fluids and solid food. | The participants are followed up until the end of hospital stay, an expected average of 7 days |
| Barthelindex | Score of the Barthel Index ranging from 0 to 100 were collected when 0 is the minimum (worst outcome) and 100 is the maximum (best outcome). Score was reported as mean score of the Barthel Index. | Up to one year |
| Patient-related outcome measures (PROMS) | Different tools and questionnaires are combined to measure Patient-related outcome. | Up to one year |
| Patient-related experience measures (PREMS) | Patient-reported experiences of health care are measured with a questionnaire. | Up to one year |
| Therapy recommendations | Therapy recommendations are documented from patient records. | Up to one year |
| Survival | Survival is measured in Patients form QV-POD-2 within 1 year; Survival is measured in patients from QV-POD-1 until 3 months (addendum to the secondary outcome measures from the ethics amendment vote of 28/08/2025) and in patients from QV-POD-2 as Interim analysis of 3-month mortality among QV-POD-2 patients from the recruitment period: July 1, 2023 - December 1, 2025, and then annually in December until the end of the study. | Up to one year |
| Establish a real time patient monitoring platform of vital signs | Continous patient monitoring of physiological data - measured by CardioWatch 287-2 during hospital stay. | 18.06.2026 - 18.08.2026 |
| At baseline |
| Preoperative risk score for delirium | Development of a risk model with different influencing factors of delirium | At baseline |
| Preoperative sober times | At baseline |
| Department of Anesthesiology and Intensive Care Medicine (CCM/CVK) Berlin, Carité - Universitätsmedizin Berlin | Recruiting | Berlin | 13353 | Germany |
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