The value of embedded electronic clinical decision support for cognitive screening in an acute hospital population

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Lucy Chapman and Brian Lawlor

St. James’s Hospital, Ireland
Trinity College Dublin, Ireland
Global Brain Health Institute, Ireland

: Int J Ment Health Psychiatry

Abstract

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Introduction: Clinical Decision Support (CDS) is a process for assisting health-related decisions with relevant, ordered clinical knowledge and patient information. The alignment of cognitive screening with information technology may offer a strategy to facilitate identification and management within an acute hospital. An audit of paper-based cognitive screening revealed objective screening was performed in only 21% of hospital admissions. Following this validated 4 A’s Test (4AT) screening tool was incorporated into the electronic health record. The diagnosis of dementia was captured within a structured field.

Method: In line with NICE guidelines, cognitive screening was mandated using a hard stop on all inpatients admitted aged 65 years and over at 24 hours into admission. An implementation strategy was undertaken using stakeholder workshops and clinical engagement. At 10 am on June 27th, 2018, the 4AT electronic tool was switched on. It triggered on all existing inpatients facilitating a point prevalence assessment of dementia and delirium across the institution..

Result: In the first 24 hours of switch-on, 324 4AT assessments were completed. The average length of stay amongst the sample was 51.9 days (SD 75 days) with an average age of 80 years (SD 8.1 years). Females were more common than males (54% versus 46%). 20% of patients had a 4AT score of 4 or more suggestive of underlying delirium. A diagnosis of dementia was documented in 23% whilst 50% of these patients had a 4AT score of 4 or more. Furthermore, 20% of patients were identified as being at risk of previously undiagnosed cognitive impairment..

Conclusion: Electronic CDS may offer a future path to augment hospital-wide screening for cognitive impairment and delirium detection. The capture of structured diagnoses could facilitate institutional awareness of cognitive impairment and delirium and enhance the delivery of patient-focused care.

Biography

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Lucy Chapman has completed her Degree in Medicine from the Trinity College. She is currently a Physician Lead on the implementation of an electronic medical record at St. James’s Hospital and is pursuing future Specialist Medical Training in Geriatric Medicine.

E-mail: chapmale@tcd.ie