Abstract
Background
Patients aged over 65 years old account for a significant proportion of the attendances to emergency departments (EDs). Cognitive impairment (CI), including delirium and dementia, can be a common finding in this population and when undiagnosed, can be a significant contributor to morbidity and mortality. Our aim is to audit, against clinical standards, the assessment of cognitive impairment in those aged over 65 in the Birmingham City Hospital ED.
Standard
- All patients aged over 65 are assessed for CI in ED, using a validated tool.
- Whenever CI has been identified, there is documented evidence that this information was included in the ED discharge letter.
Methods
A retrospective pre- and post-intervention audit method was used. Intervention included educational posters displayed amongst clinical areas within the ED and raising clinician awareness on the topic during clinical handovers and educational teaching sessions.
Results
In the pre-intervention period, 7 out of a total of 240 (2.9%) patients had written evidence of a cognitive assessment using a validated tool and this improved to 13 out of a total 100 patients (13%) in the post-intervention period. AMTS was found to be the most common tool used. Communication of any identified cognitive impairment to GP increased from 0 out of 4 identified patients (0%) in pre-intervention period to 3 out of 6 patients (50%) post-intervention.
Conclusion
Despite the potential significant impact of cognitive impairment in older people, there is very little documented evidence of cognitive assessment within our emergency department. We demonstrate an improvement in this following intervention. However, the proportion of cognitive assessments being done remains low.