Cognitive screening of older hospital patients: a quality assurance study

Objective: To evaluate the impact of two educational techniques on the rate of cognitive screening of patients referred to a hospital aged care service. Method: Audit of documentation of cognitive status in the medical record of patients aged 65 years or older referred for aged care consultation in an acute teaching hospital following two interventions: a general education program, and a general education program complemented with a pocket-sized laminated Abbreviated Mental Test card. Results: Cognitive impairment, defined as Abbreviated Mental Test (AMT) score of 7 or less was present in 49.9% of patients referred for geriatric consultation over a four year period. Documentation of cognitive state by the referring unit, within forty-eight hours of admission, using a recognised mental status screening instrument was initially 9.4%. Following an education program, documentation of cognitive screening increased to 18.1%, with a further improvement to 28.2% occurring when the education program was supported with a memory aid, a laminated pocket-sized AMT card. In the following year when the card was provided without an education program, the rate of cognitive screening fell to 13.4%. (p<.0001). The average frequency of a written description of cognition was 50.2% over the four years, and did not increase with the educational programs. Conclusions: Cognitive screening is infrequently performed on older hospital inpatients referred for geriatric consultation, despite a high prevalence of cognitive impairment in this patient group. The rate of cognitive screening can be influenced by the use of art educational program, and further improved with a memory aid. A memory aid without an educational program is less effective.