From Combat Delirium to Calm Recovery: Pitt Nursing & Pittsburgh VA Cut ED in PTSD Patients by 90%

Witnessing veterans jolt awake in terror—thrashing violently, self-extubating tubes, and injuring themselves and staff—the VA Pittsburgh team refused to accept emergence delirium as an unavoidable risk. They rolled out a gold-cap identification system and a multicomponent, evidence-based intervention comprising 21 clinical strategies: routine PTSD risk screening, enhanced staff communication, environmental modifications to soothe disorientation, tailored anesthetic medication protocols, and clear guidelines for manual restraint. Every perioperative team member completed hands-on training reinforced by recorded demonstrations, ensuring consistency and confidence at every hand-off.

The results were dramatic. Emergence delirium rates among high-risk veterans plunged by 90%—from 27% to just 2.7%—and wake-up injuries to both patients and staff vanished. Lost IV lines and compromised airways became stories of the past, replaced by gratitude from veterans who no longer “wake up in Iraq.” The program’s success earned a 2020 Gears of Government Award and a 2021 Patient Safety Achievement Award, and VA centers nationwide are now adopting this new standard in compassionate, trauma-informed perioperative care

Pittwire Article: A training program is making surgery easier on veterans and safer for health care staff | University of Pittsburgh

Published Research:

73483-a-perioperative-intervention-to-prevent-and-treat-emergence-delirium-at-a-veterans-a.

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