Perioperative Brain Bundle Linked to Net Savings

Key Takeaways

• In a single-center Swiss hospital model, implementing a perioperative brain healthcare bundle was associated with 300 fewer PACU-detected postoperative delirium events, 421 hospital days saved, and CHF 389 523 in net savings within 12 months (95% CI 159 209 to 688 988).
• Across 6918 eligible elective inpatient surgeries, a modeled full-coverage, upper-bound implementation scenario estimated 803 hours and CHF 326 612 over 12 months, representing a modeled operational lift rather than a directly observed incremental burden because not all patients were actually screened during rollout.
• The bundle combined 18 non-pharmacological recommendations across three perioperative phases, and staff interviews suggested generally positive acceptance after a learning curve, although paper forms and later manual digitization added workflow burden.

Implementing a perioperative brain healthcare bundle was linked in a hospital-level model to CHF 389 523 in projected net savings within 12 months, alongside fewer PACU-detected postoperative delirium events, according to a perioperative brain healthcare bundle analysis. This was a retrospective mixed-methods, single-center economic and implementation evaluation at Salem-Spital Bern rather than a controlled efficacy comparison. The authors reported that modeled savings reached breakeven at about 2 months, underscoring that the economic return was estimated rather than directly observed.

The study used a retrospective convergent mixed-methods case-study design at Salem-Spital Bern from January 2023 to January 2024 and covered 6918 elective inpatient surgeries across eight operating rooms. Alongside a hospital-perspective economic model, investigators conducted 10 semi-structured staff interviews to examine implementation experience. Adopted from the Safe Brain Initiative, the perioperative brain healthcare bundle comprised 18 evidence-based non-pharmacological recommendations delivered across three perioperative phases; the hospital implemented the program through assessment, initiation, and running phases, with PROMs and PREMs collected at four time points; data were recorded on paper case report forms and monitored through a real-time dashboard.

Over 12 months, under a modeled full-coverage, upper-bound scenario across 6918 eligible elective inpatient surgeries, implementation was estimated to require 803 hours, with a 95% CrI of 695 to 912, and CHF 326 612, with a 95% CrI of 275 370 to 374 781, averaging 6.96 minutes and CHF 47.2 per patient under that model, although not all patients were actually screened during rollout. Comparing the first and last 6 months of implementation, the model estimated a 19% decline in PACU-detected postoperative delirium, from 22.45% to 18.11%, corresponding to 300 fewer events with a 95% CrI of 270 to 330 and 421 hospital days saved with a 95% CI of 341 to 509. These estimates were generated within the implementation period rather than against a separate preimplementation control group.

PACU-detected delirium was defined by a Nursing Delirium Screening Scale score of 2 or higher at PACU transfer or discharge, using the highest recorded score, and the analysis compared the first versus last 6 months of rollout because preimplementation PACU screening data were unavailable. Deterministic sensitivity analysis identified the percentage difference in PACU-detected delirium, the cost per hospital day, and the length-of-stay reduction associated with avoided delirium as the main drivers of savings. Interviewed staff generally described the bundle as manageable after a short learning curve, but paper questionnaires during PACU transfer and subsequent manual digitization were cited as added workflow steps, while the single-center observational design and PACU-only detection frame limit causal interpretation; under a 5-year scenario, projected cumulative savings reached CHF 2 334 736 (95% CrI 1 209 089 to 3 823 969).

Clinician Questions

How much staff time and hospital cost were involved in implementing the perioperative brain healthcare bundle at Salem-Spital Bern?

In the Salem-Spital Bern implementation analysis, the perioperative brain healthcare bundle was estimated to require 803 staff hours over 12 months and CHF 326 612 in total cost across 6918 elective inpatient surgeries, averaging 6.96 minutes and CHF 47.2 per patient. The report also separated that estimate into 161 hours of one-off initiation time and 642 hours of recurrent implementation time.

How was postoperative delirium measured in the Salem-Spital Bern perioperative brain bundle analysis?

In the Salem-Spital Bern perioperative brain bundle analysis, postoperative delirium referred to PACU-detected delirium measured with the Nursing Delirium Screening Scale, using a Nu-DESC score of 2 or higher at PACU transfer or discharge based on the highest recorded score. The estimates therefore apply specifically to PACU-detected episodes and may not capture ward-based or later-onset delirium.

What reduction in postoperative delirium and hospital use was estimated after perioperative brain healthcare bundle implementation?

In the observational implementation analysis at Salem-Spital Bern, the modeled comparison between the first and last 6 months of perioperative brain healthcare bundle use showed PACU-detected postoperative delirium declining from 22.45% to 18.11%, equivalent to 300 fewer events, a 19% decrease, 421 hospital days saved, and projected net savings of CHF 389 523 within 12 months. The authors presented these as modeled estimates from an implementation evaluation rather than as causal treatment effects.