Abstract Introduction Lagan Valley Hospital is 80 bedded district general hospital offering acute medical specialty admissions. Over 70% of admissions relate to older adults ( 65 years). Previous focused audits demonstrated high prevalence of delirium and undiagnosed dementia. Chart reviews highlighted variation in completeness and quality of cognitive history taking by all members of the multidisciplinary team. Development of a cognitive history template offers potential to improve patient care. Method Survey of doctors to assess baseline confidence in cognitive history taking, audit of in-patients ( 65 years) to assess cognitive history taken and by whom, development of electronic tool to screen for delirium and underlying cognitive impairment. Ward-based multidisciplinary education and subsequent dissemination of an electronic cognitive history template to all resident doctors. Results Our survey demonstrated that doctors were aware of many components required to take a cognitive history, but their confidence in completing the history was low. Audit of admissions showed that the majority of cognitive histories were obtained by specialist frailty nurses. Many older adults presenting with confusion did not have a cognitive history taken. Use of an electronic cognitive history template supported consistency across all ward areas and across the multidisciplinary team. Feedback on use of the template from members of the multidisciplinary team was positive. Conclusions Development of an electronic cognitive history template has ensured consistency of approach in collateral history taking, as well as better identification of patients with/at risk of delirium, particularly identifying those who may have underlying but undiagnosed cognitive impairment who may benefit from earlier referral to Memory services. As Encompass (EPIC) has now been adopted by all hospitals in Northern Ireland, it is possible for this to be more widely applied across healthcare trusts.
Thompson et al. (Sun,) studied this question.