Introduction
A significant portion of hospital admissions involve older patients with underlying cognitive impairment. Nevertheless, measurement of baseline cognition and identification of confusion in older patients remain suboptimal. To address this, the Care of Confused Hospitalised Older Persons initiative recommends cognitive screening using a standardised tool within 24 hours of hospital admission in all non-Indigenous patients aged 65 years and above and all Indigenous patients aged 45 years and above.
Aim
The aim of this clinical audit is to identify if the local hospital practice of baseline cognitive screening in Wagga Wagga Base Hospital aligns with the national and state-wide recommendations.
Method/Description
This clinical audit involved the use of the Discern Analytics 2.0 program to retrospectively locate all Aboriginal and Torres Strait Islander patients aged 45 years and above, and all non-Aboriginal and Torres Strait Islander patients aged 65 years and above, who were in-patients in Wagga Wagga Base Hospital over a twelve day period. Data was collected for different medical and surgical wards. A filter was applied to each electronic patient record to search for whether an Abbreviated Mental Test Score (AMTS) was performed throughout the admission, and whether this was performed within 24 hours of admission, or at more than 24 hours after admission.
Results
Baseline audit of 164 patients showed overall poor compliance to the recommended practices of baseline cognitive assessment. 33% of total sampled patients received an AMTS within 24 hours of admission, while 58% of patients did not have an AMTS performed during their admission. In comparison, the medical wards had a marginally higher performance rate of AMTS within 24 hours of admission (38%) than the surgical wards (30%). Among the medical wards, the Coronary Care Unit had the highest completion rate of AMTS within 24 hours of admission (57%), while the Stroke Unit had the lowest rate (0%). The Orthopaedic ward also performed better at screening patients within 24 hours of admission (35%) compared to the Surgical ward (22%).
Consclusions
This clinical audit highlighted the need to improve baseline cognitive assessment in older patients upon admission to Wagga Wagga Base Hospital. Barriers to performing baseline cognitive assessment may include time constraints, limited staff awareness of the utility of baseline cognitive screening and competing clinical tasks. To improve the current local practice, a comprehensive education approach for clinical staff is critical. This can be achieved through the individual, ward, hospital and external levels. Following the education interventions, future studies should be performed to assess whether the completion rates of admission cognitive assessment have improved.