Identification and information management of cognitive impairment of patients in acute care hospitals: An integrative review.
Beibei Xiong, Daniel X Bailey, Paul Prudon and 5 others
PMID 38352291WHAT IT FOUND
Cognitive impairment in acute hospitals was often missed, undocumented, or not shared with patients, families, or primary care doctors, even when guidelines required screening and communication.
For clinicians, this means screening cognition at admission and making sure results are recorded, handed over, and explained.
Key findings
01In 19 of 22 included practice studies, two-thirds of cognition information sources were routine admission assessments; among studies that reported a tool, CAM or CAM-ICU and 4AT were most common, and only one study explicitly reported assessment within 24 hours.
02Among 19 studies reporting data transparency, cognition information was most often recorded and stored in patient health records (n = 12), but two reported fragmented practice where screening was not documented; only 7 of 22 studies reported discharge summary or GP referral, and none reported how long the information remains current.
03Information about patient interaction came from 9 of 22 studies; it was valued but lacking in six, while three reported education and support. Only half of carers in a study had been asked about cognitive changes, fewer than half felt invited to contribute, and only one in seven had received delirium prevention information.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for RNs
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What it does not show
The review included many different study designs and settings, so it describes patterns rather than measuring how well any practice works. Several included studies did not meet quality criteria, with problems such as low response rates, small samples, incomplete data, and unadjusted confounders. The review focused on acute care hospitals, so it may not apply to emergency, outpatient, rehabilitation, post-acute, palliative, maternity, or paediatric settings. It treated cognitive impairment, mild cognitive impairment, delirium, and dementia together, so it did not compare the specific meaning or tools for each condition. Data transparency was poorly reported, and the review found no studies of the whole process of sharing cognitive information through an episode of care. Searches were limited to English-language publications and national databases, so state or provincial guidelines may have been missed. Recommendations come from a review of practice and policy, including patient and carer priorities, not from tested interventions.
Declared interests
The authors declared no conflict of interest. The work was funded by the Australian National Health and Medical Research Council.
The easy way to misread this
Do not read this as proof that routine cognitive screening improves patient outcomes. It is a review of practice and policy, many included studies were low quality, and it did not test whether these recommendations change care.