Implementation and economic analysis of a perioperative brain healthcare bundle: a mixed-methods study.

Abstract

Mixed-methods observational implementation and economic evaluation study. Perioperative care bundles have the potential to improve patient outcomes but their successful implementation depends on staff engagement and the resources required. Data on implementation costs and staff perceptions are limited for perioperative brain health initiatives. To estimate the resource use and costs of implementing a perioperative brain healthcare bundle in a Swiss hospital and to explore staff perceptions relevant to sustainable adoption. Retrospective mixed-methods study combining semi-structured interviews with economic modelling. Single tertiary-level Swiss hospital. Cost estimates were expressed in 2024 Swiss Francs (CHF). Five anaesthesiologists and five nurses involved in perioperative care and bundle implementation were interviewed using semi-structured interviews. Postoperative delirium incidence was assessed in patients admitted to the post-anaesthesia care unit (PACU). Implementation of a perioperative brain healthcare bundle, including staff training, workflow adaptation and routine postoperative delirium screening. Primary outcomes were total implementation time and costs, and postoperative delirium incidence in the PACU measured using the Nursing Delirium Screening Scale. Secondary outcomes included staff perceptions of workload and feasibility, hospital length of stay and net cost impact. Staff perceptions of the care bundle were generally positive, with initial concerns about workload decreasing over time. Implementation required an estimated 803 hours (695-912) and cost CHF 326 612 (275 370-374 781). The economic model estimated a reduction of 300 (270-330) PACU-detected postoperative delirium cases, corresponding to 421 (341-509) hospital days saved and net cost savings of CHF 389 523 (159 209-688 988) within 12 months. Scenario and probabilistic sensitivity analyses projected cumulative net savings exceeding CHF 2 million over 5 years, with a breakeven point at approximately 2 months. Implementation of a perioperative brain healthcare bundle was well accepted by staff and associated with substantial cost savings in this single-centre model-based analysis, supporting its potential scalability as a perioperative quality improvement intervention.