Evaluation of a method to estimate the point prevalence of cognitive impairment and delirium in a multi‐campus Australian health service

Casey, Penelope; Dārziņš, Pēteris; Mart, Melinda Webb‐St; Baldwin, Cathryn; Riddell, Kath; Johnson, Claire; Cross, Wendy

doi:10.1111/ajag.12666

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…However, more information is needed about the accuracy of the 4AT in different ethnicities and languages. For instance, a previous study reported confusion among pilot surveyors when completing the 4AT in languages such as Mandarin, where numbers represent the months of the year [ 30 ]. A particular concern was the reliance on family interpreters despite the availability of professional interpreters for patients with limited English and deafness.…”

Section: Discussionmentioning

confidence: 99%

Barriers to completing the 4AT for delirium and its clinical implementation in two hospitals: a mixed-methods study

Alhaidari

Matsis

2021

Eur Geriatr Med

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Purpose To assess the clinical implementation and barriers to completing the 4AT for delirium in general medical and geriatric patients over 75 years upon admission to Wellington and Kenepuru Hospitals during the first eight months of 2017, 2018 and 2019. Methods Retrospective data from electronic health records were analysed using an explanatory-sequential mixed-methods approach. The initial quantitative phase measured doctors’ adherence to the 4AT and the rate of positive 4ATs (≥ 4). The subsequent qualitative phase identified doctors’ main reasons for omitting the 4AT through conventional content analysis. Results The quantitative population included 7799 acute admissions (mean age 84, 58.2% female). There was good clinical implementation of the 4AT, evidenced by an overall adherence rate of 83.2% and a rate of positive 4ATs of 14.8% that is in keeping with expected delirium rates in similar settings. The qualitative sample consisted of 875 acute admissions (mean age 84, 56.3% female) with documented reasons for omitting the 4AT. The main barriers to completing the 4AT were: reduced patient alertness, communication barriers (language, deafness, aphasia and dysarthria), prioritising patients’ wellness and comfort (addressing critical illnesses, symptoms, end-of-life issues and promoting sleep), pre-existing cognitive disorders, and unstructured delirium assessments. Conclusion Adherence to the 4AT was high and sustainable in both hospitals. Most barriers to completing the 4AT were potentially avoidable. Education about the 4AT in relation to these barriers may improve its implementation.

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Section: Discussionmentioning

confidence: 99%

Barriers to completing the 4AT for delirium and its clinical implementation in two hospitals: a mixed-methods study

Alhaidari

Matsis

2021

Eur Geriatr Med

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The impact of a cognitive impairment support program on patients in an acute care setting: a pre-test post-test intervention study

et al. 2023

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Background Patients with cognitive impairment are at greater risk of hospital acquired complications, longer hospital stays, and poor health outcomes compared to patients without cognitive impairment. The Cognitive Impairment Support Program is a multi-disciplinary approach to improve screening rates and awareness of patients with cognitive impairment and guide clinician response and communication during their hospitalisation to improve health outcomes. Objective This study evaluated the impact of implementing the Cognitive Impairment Support Program on patient hospital acquired complications, patient reported quality of life and staff satisfaction in an outer metropolitan hospital. Design A pre-test post-test design was used to collect data in two 6-month time periods between March 2020 and November 2021. Participants Patients aged ≥ 65 years, admitted to a participating ward for > 24 h. Intervention The Cognitive Impairment Support Program consisted of four components: cognitive impairment screening, initiation of a Cognitive Impairment Care Plan, use of a Cognitive Impairment Identifier and associated staff education. Measures The primary outcome was hospital acquired complications experienced by patients with cognitive impairment identified using clinical coding data. Secondary outcomes were patient quality of life and a staff confidence and perceived organisational support to care for patients with cognitive impairment. Results Hospital acquired complication rates did not vary significantly between the two data collection periods for patients experiencing cognitive impairment with a 0.2% (95% confidence interval: -5.7–6.1%) reduction in admissions with at least one hospital acquired complication. Patients in the post intervention period demonstrated statistically significant improvements in many items in two of the Dementia Quality of Life Measure domains: memory and everyday life. The staff survey indicated statistically significant improvement in clinical staff confidence to care for patients with cognitive impairment (p = 0.003), satisfaction with organisational support for patients (p = 0.004) and job satisfaction (p ≤ 0.001). Conclusion This study provides evidence that a multicomponent Cognitive Impairment Support Program had a positive impact on staff confidence and satisfaction and patient quality of life. Broader implementation with further evaluation of the multicomponent cognitive impairment intervention across a range of settings using varied patient outcomes is recommended.

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Detecting delirium: a systematic review of ultrabrief identification instruments for hospital patients

Liu

et al. 2023

Front. Psychol.

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ObjectiveEarly identification of delirium, which often occurs in older patients, can effectively reduce adverse prognoses. One way to increase the detection rate of delirium is to use an effective ultrabrief instrument for higher-frequency screening. The purpose of this review is to evaluate the diagnostic accuracy of ultrabrief screening tools for delirium.MethodsThe Cochrane Library, PubMed and EMBASE were searched from January 1, 1974, to November 31, 2022. We assessed the measurement properties of screening instruments using the consensus-based standards for selecting health measurement instruments (COSMIN) checklist and evaluated the risk bias of the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The diagnostic test accuracy of instruments for delirium was reported using sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR).ResultOf the 4,914 items identified, 26 met the eligibility criteria, resulting in 5 different delirium identification tools. The overall study quality assessed by the QUADAS-2 tool was moderate to good. Of the five screening tools, two instruments had sensitivity ≥80% and specificities ≥80%: 4AT and UB-2. The most comprehensive is the 4AT scale, which has a sensitivity of 0.80 [95% confidence interval (CI):0.68, 0.88] and a specificity of 0.89 (95%CI: 0.83, 0.93) and contains 4 items. UB-2 has a sensitivity of 0.88 (95%CI: 0.72, 0.96) and a specificity of 0.64 (95%CI: 0.56, 0.70).ConclusionUB-2 and MOTYB had excellent sensitivity for delirium screening at an early stage. In terms of sensitivity and intentionality, the 4AT is the best recommended scale.

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Evaluation of a method to estimate the point prevalence of cognitive impairment and delirium in a multi‐campus Australian health service

Cited by 3 publications

References 28 publications

Barriers to completing the 4AT for delirium and its clinical implementation in two hospitals: a mixed-methods study

Barriers to completing the 4AT for delirium and its clinical implementation in two hospitals: a mixed-methods study

The impact of a cognitive impairment support program on patients in an acute care setting: a pre-test post-test intervention study

Detecting delirium: a systematic review of ultrabrief identification instruments for hospital patients

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