The QEII Hospital is a metropolitan adult facility providing a range of inpatient and outpatient services and a 24-hour emergency department in Metro South Health in Brisbane.
The University of Queensland Centre for Health Services Research is based at QEII and is conducting two projects related to the care of patients with cognitive impairment.
The research team is working with hospital staff to trial a new nurse assessment system that is compact yet precise in its design. It responds to the burgeoning demand on nurses to meet a growing list of important items in the National Safety and Quality Health Service Standards, including cognitive impairment. It is designed reduce documentation burden. Among its many functions, the system helps to identify patients with cognitive impairment, delirium, under-nutrition and risks of adverse events such as falls and pressure injury. It is configured for use on tablets and desktop computers. It enables shift by shift changes in patient status, and automatically recalculates diagnostic and risk screeners.
The implementation commenced in February 2018 and by April had been implemented across most of the hospital. Preliminary feedback suggests good acceptance by nursing staff, time savings (average completion time 15 minutes) and improved compliance with documentation. The trial will report formal findings later in 2018.
The interRAI Acute Care system enables calculation of nine outcome oriented quality indicators that are highly relevant to the care of older hospital patients with cognitive impairment. These patients are particularly at risk of delirium, falls, pressure injury, functional decline and discharge to long term at discharge. Thorough assessment and care planning will probably mitigate these risks.
In an NHMRC funded grant, UQ Centre for Health Services Research staff are planning to implement the interRAI AC system in 8 hospitals, in order to score the quality indicators. The resulting information will enable hospitals to make within and among hospitals comparisons using aggregated data based on the indicators. We anticipate that this will lay a platform for robust quality improvement for all frail older hospital patients, particularly those with dementia.
The project is currently recruiting hospitals to the trial. It is expected to produce final results in 2021.