Around 30% of patients over 70 years of age experience Cognitive Impairment during hospitalisation.1 Cognitive impairment is a source of risk in the busy acute hospital environment where patients with dementia have 2.5 times the risk of an adverse event compared to patients without dementia.2 Research identifies that 28% of patients admitted to hospital with dementia experience an adverse event.3
In 2018, Redcliffe Hospital hosted a meeting with university, consumer and collaborative organisations to explore possible research opportunities that aligned with their strategic direction of improving care of frail and older patients in the acute care setting. This meeting saw the initiation of local research3 that identified a number of opportunities in relation to patients experiencing cognitive impairment in acute settings and the subsequent Program implementation.
The Cognitive Impairment Support (CIS) Program is derived from the Dementia Care in Hospitals Program, originally implemented at Ballarat Hospital and now accepted practice in a number of hospitals across four Australian states.4 The CIS Program aims to use an all of hospital approach to improve awareness of and communication with patients experiencing CI. The program will: (1) increase the rate of CI screening using the 4AT tool5 on admission, (2) embed use of a revised care pathway, (3) use a Cognitive Impairment Identifier6 at the patient’s bedside, and (4) educate clinical and non-clinical hospital staff in communication techniques most suitable for patients with cognitive impairment. This program is unusual in that all hospital staff who have direct contact with patients will undertake the program using a train-the-trainer approach. This is inclusive of healthcare clinicians and operational support staff such as administration officers, catering, porters and volunteers.
The CIS Program is a nurse-led multidisciplinary and cross institutional study and the investigative team were successful in securing a competitive Nursing and Midwifery Research Fellowship to implement and evaluate the programs’ effectiveness at one site with the view of informing implementation state-wide. The Program will be implemented at Redcliffe Hospital over an 18-month period and forms part of the hospital’s strategic priority ‘to improve care of the frail and older adult’.
The Program will be evaluated using a before and after study design across five acute care wards. Evaluation of the impact the CIS Program has on patient outcomes, staff and carer satisfaction and from a health economic perspective will be undertaken. In particular, hospital acquired complications such as pneumonia, urinary tract infection, pressure injury, fall and delirium will be measured along with cost per hospital episode. Patient and care partner feedback will be sought using the DEMQOL7, quality of life survey and a carer satisfaction survey. Staff knowledge and confidence in caring for patients with cognitive impairment will also be examined before and after implementation of the Program using a survey. A sub-study will explore the impact the CIS Program has on rates of constant patient observation during hospitalisation for patients experiencing cognitive impairment.
The successful uptake of the CIS Program is expected to improve identification of patients experiencing cognitive impairment, leading to better care and reduced hospital acquired complications and healthcare costs. Pre-implementation data collection began early this year, however, due to COVID-19 the Program has been temporarily placed on hold. Outcomes of the Program are anticipated by the end of 2021.
The findings from this research will inform future clinical practice, models of care and possibly procedures and policy related to the care of people with cognitive impairment in acute care settings in Queensland. If implementation of the CIS Program at Redcliffe Hospital is found to successfully reduce the frequency of hospital acquired complications and associated cost effectiveness indicators or improve the hospital experience for patients with cognitive impairment or their care partners, scaling up and implementation across other acute and subacute settings is recommended.