Postoperative delirium is a common, dangerous and costly complication of surgery. It is linked to higher mortality, more complications and longer hospital stays. As surgical patients age and become more medically complex, it is expected to become more common.
Yet delirium is often preventable. At the Royal Adelaide Hospital, the Advanced Recovery Room Care (ARRC) team is showing how enhanced postoperative care can help.
A proactive bundle of care
ARRC has introduced a delirium-prevention bundle for high-risk patients. It focuses on non-drug strategies that help patients stay calm, oriented and engaged in their recovery.
High-risk patients are screened for delirium and cognitive impairment within hours of arriving in ARRC. Early detection lets staff respond with orientation and comfort measures, rather than medication.
The bundle includes:
handmade twiddle mats
dementia clocks
earplugs and eye masks
Bluetooth speakers
family involvement and reassurance from staff.
Staff also check pain, hydration and nutrition. They make sure patients have their hearing aids, glasses and dentures.
Made by the community
A local community sewing group makes the twiddle mats in partnership with the ARRC team. Each mat has tactile features, such as zips, buckles, buttons, Velcro and even a padlock and key.
When a confused patient reaches for a line or tube, staff can redirect their attention to the mat. Volunteers keep developing new designs, and some mats are tailored to patients’ interests, such as fishing.
ARRC Associate Nurse Unit Manager Melissa Kairl says the mats give patients “something familiar and purposeful to focus on.”
Who is most at risk
Consultant Geriatrician and Perioperative Medicine Physician Dr Victoria Gibson explains that patients most at risk include people:
living with dementia
aged 70 or older
taking multiple medications, or with recent medication changes.
Frailty, multiple medical conditions and sensory impairment add to the risk. These patients have less reserve to cope with surgical stress.
Unlike dementia, delirium comes on suddenly and fluctuates. Detected early and managed well, it is often reversible.
Why it matters for enhanced care
Enhanced postoperative care units are well placed to prevent delirium. Close monitoring and higher nurse-to-patient ratios mean staff notice subtle changes in attention or behaviour early.
ARRC’s bundle shows that other EPOC units can build low-cost, person-centred measures into everyday postoperative care and adapt them.
Read the original article on the CALHN website →
Adapted with permission from Central Adelaide Local Health Network, 22 September 2026.
