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Delirium in Old AgeNCT04355195

Quality Contract: Prevention of Postoperative Delirium in the Care of Older Patients (QV-POD-2)

An observational study of Delirium in Old Age, run by Charite University, Berlin, Germany at 2 sites in Germany.

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Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

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… Read more about this study

Who is it for?
Ages 70 years and older
Conditions the study is for
Delirium in Old Age
How many people
18,100 participants
Where
2 sitesGermany
Study dates
20 Apr 2020to Jun 2029
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 70 years and older
  • All sexes
  • Older adult

Study population: Patients aged ≥70 years, male and female, who are receiving surgery

Who may be able to join

  • Age ≥ 70 years
  • male and female patients
  • Patients who are insured with BARMER, HEK, KKH, DAK, TK or hkk Health insurances
  • Patients eligible for inclusion: by the patient, preoperatively
  • Incapacitated patients for inclusion: Written informed consent by a legal representative
  • surgery (elective and not elective)

Who cannot join

  • Moribund patients
  • Not enough language skills

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Claudia Spies, MD, Prof. contact

+49 30 450 55 11 02

claudia.spies@charite.de

Germany2 sites, 2 recruiting
  • Department of Anesthesiology and Intensive Care Medicine (CBF), Charité - Universitätsmedizin Berlin

    Berlin, 12203

    Sascha Treskatsch, MD. Prof., +49 30 450 55 15 22, sascha.treskatsch@charite.de

    Sascha Treskatsch, MD, Prof.

    Recruiting
  • Department of Anesthesiology and Intensive Care Medicine (CCM/CVK) Berlin, Carité - Universitätsmedizin Berlin

    Berlin, 13353

    Caudia Spies, MD, Pof., +49 30 450 55 11 02, claudia.spies@charite.de

    Claudia Spies, MD, Prof.

    Recruiting

Other trials in Germany

About this study

Official title: Quality Contract Prevention of Postoperative Delirium in the Care of Older Patients (QV-POD-2)

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:

Read more

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, August or September 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.

Subproject started in July, 2026:

Economic analysis conducted by Cellogic as a contract research project-selected clinical trial data from the clinical trial database and selected data from the Institute for the Hospital Payment System (InEK), cost unit accounting, and OPS codes will be evaluated for patients form QV-POD-1

Read the detailed description

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.

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT04355195
Study groupRoleWhat they receive
Cohort before training500 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 1From 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 2023From July 1st, 2023, the documentation of the routine data will go on: 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, 2028.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 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.

    Measured: Up to 5 years

  2. 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)

    Measured: Up to 3 years

Secondary outcomes (47)
  1. 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

    Measured: Up to 5 years

  2. 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)

    Measured: Up to 5 years

  3. Care level

    The care level is taken from hospital records preoperatively and postoperatively

    Measured: Up to one year

  4. Routine laboratory

    Routine laboratory markers

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  5. Routine vital parameters

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  6. Measurement of cholinesterases

    Cholinesterases (point of care testing (POCT) measurements) are measured in the routine

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  7. Intraoperative routine data

    Measured: Time of surgery

  8. Postoperative routine data on the ICU, in the recovery room and normal ward

    Measured: The participants are followed up until the end of hospital stay, an expected average of 7 days

  9. Drug administration during inpatient treatment

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  10. Routine preventive measures against delirium

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  11. Intraoperative documented peculiarities in patients with delirium

    Measured: Time of surgery

  12. 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.

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  13. 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)

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  14. 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).

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  15. Electroencephalography (EEG) measurement

    Objective non-invasive EEG is measured intraoperatively

    Measured: During the duration of surgery, an expected average of 2 hours

  16. Infections

    Infections according to surgical site infections (SSI) and according to the US Centers for Disease Control and Preventions (CDC).

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  17. Quality of life 1

    Health related quality of life is measured by EQ-5D-5L (Patient and Proxy 1)

    Measured: Up to one year (18 months)

  18. 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.

    Measured: Up to one year

  19. Postoperative complications

    To evaluate the presence or development of postoperative organ complications during inpatient care

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  20. Analgesia consumption

    Concomitant pain medication is recorded

    Measured: Up to one year

  21. 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.

    Measured: Up to three months

  22. 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).

    Measured: Up to one year

  23. 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.

    Measured: Up to one year

  24. 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).

    Measured: Up to one year

  25. Intensive care unit length of stay

    Intensive care unit length of stay is measured in days

    Measured: Participants will be followed for the duration of intensive care stay, an expected average of 2 days

  26. Hospital length of stay

    Hospital length of stay is measured in days

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  27. 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.

    Measured: Up to one year

  28. 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.

    Measured: Up to one year

  29. 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.

    Measured: Up to one year

  30. 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.

    Measured: Up to one year

  31. 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.

    Measured: Up to one year

  32. 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).

    Measured: Up to one year

  33. Disability 2

    Disability 2 is measured by Timed up and go test.

    Measured: Up to one year

  34. Disability 3

    Disability 3 is measured by hand grip strength test

    Measured: Up to one year

  35. Anxiety-Score

    Faces Anxiety Scale score

    Measured: Up to one year

  36. Sedation

    Sedation is measured with the Richmond Agitation and Sedation Scale (RASS)

    Measured: Up to one year

  37. 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.

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  38. Permanent medication

    Medication at three months compared to baseline is assessed.

    Measured: Up to one year

  39. Frailty status

    Frequency of frailty is measured by modified Fried criteria (category 1 +2 = pre-frail, category 3 -5 = frail)

    Measured: Up to one year

  40. Postoperative oral ingestion

    Ingestion is measured by the amount of fluids and solid food.

    Measured: The participants are followed up until the end of hospital stay, an expected average of 5 days

  41. 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.

    Measured: Up to one year

  42. Patient-related outcome measures (PROMS)

    Different tools and questionnaires are combined to measure Patient-related outcome.

    Measured: Up to one year

  43. Patient-related experience measures (PREMS)

    Patient-reported experiences of health care are measured with a questionnaire.

    Measured: Up to one year

  44. Therapy recommendations

    Therapy recommendations are documented from patient records.

    Measured: Up to one year

  45. 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.

    Measured: Up to one year

  46. Establish a real time patient monitoring platform of vital signs

    Continous patient monitoring of physiological data - measured by CardioWatch 287-2 during hospital stay.

    Measured: 18.06.2026 - 15.09.2026

  47. Economic analysis

    Data from the clinical trial database and selected data from the Institute for the Hospital Payment System (InEK), cost unit accounting, and OPS codes form QV-POD-1-patients will be evaluated.

    Measured: 01.04.2020 bis 31.12.2025

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Apr 2020
  2. Study start20 Apr 2020
  3. Primary completionJun 2028 (estimated)
  4. Study completionJun 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
18,100 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04355195
Sponsor's protocol ID
QV-POD-2
Status last verified
Aug 2026
First submitted
17 Apr 2020
Last updated
31 Aug 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • 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.

    PubMed 36878649

Questions about this trial

What is this clinical trial studying?

An observational study of Delirium in Old Age, run by Charite University, Berlin, Germany at 2 sites in Germany.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 31 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Claudia Spies, MD, Prof. (+49 30 450 55 11 02, claudia.spies@charite.de), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Sustainability of implementation rates (time frame: Up to 5 years). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04355195, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Aug 2026.

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