HSO418
INNOVATION &
EVALUATION PROJECT - 56
AN INTERDISCIPLINARY CLINICAL PATHWAY FOR ASSESSING AND TREATING COGNITIVE
IMPAIRMENT
By Shane Howard
Background and Creation of Project
◦ A lack of clarity of the processes guiding the screening and assessment of
patients cognition during inpatient rehabilitation at Barwon Health and
across Victoria.
◦ Inpatient Rehab Centre (IRC) staff reported - ambiguity around the process
governing cognitive assessment.
◦ Concerns raised,
- Working in silo can cause duplication, accuracy, and oversight in
assessments.
- Burden of unnecessary additional workload.
- The timing, type of cognitive assessment and the discipline responsible.
- The potential effects to the consumers experience and poor outcomes.
Study developed.
- Two part multi methods study is to establish a gold standard best practice
guideline for screening and assessing neurological patients’ cognition in an
IRC setting.
- Researchers; Dr Olivia King , Melissa Mew (OT), Anna McLaren (NP), Lidia
Davies (SP), Benedict Ho (OT student).
Figure 1: study method (Barwon Health,2019)
I&E Project
Project Aims
◦ To clarify current interdisciplinary roles in cognitive screening & Assessment and treatment.
Who
What
When
How
◦ Creation of a resource of roles, scopes and assessment tools used.
◦ Identify overlaps and inefficiencies in referrals and assessments.
◦ Process map current (baseline) cognitive screening/assessment/treatment processes on IRC subacute wards for neurorehabilitation patients
◦ Compare findings with literature, national guidelines and other subacute inpatient neurorehabilitation centres.
Innovation:
◦ Development of a process map of current cognitive screening and assessment.
◦ Definition of roles – who discipline does what/when for whom/list of assessments used.
Benefits
◦ Streamlining and improvement of cognitive screening and assessment in the IRC setting.
◦ Contribute to paucity of literature.
◦ Improved client outcomes with more efficient assessment, referral and treatment workflow.
◦ Increased staff awareness of processes and roles.
Method and Objectives
Timeline (including milestones)
OBJECTIVES METHOD
• Literature review and comparison. Wk 1 (12 Aug) – Describing Setting/Reviewing
◦ Research and evaluate • Admission file audit documentation of current practice
• Identify current benchmark Figure 2 ("Steve Kaufmann", 2019)
background information:
Wk 2 (19 Aug) – Work on process map / outline of roles.
Wk 3 (26 Aug) – Work on process map / outline of roles.
◦ Design and development
of resource:
Wk 4 (2 Sept) – Work on process map / outline of roles.
• Identify discipline timelines
• scope of practice.
• Research team feedback. Wk 5 (9 Sept) – Check mapping with audit of files
• Amend as required.
Wk 6 (16 Sept) – Check map with Staff
◦ Implementation: Wk 7 (23 Sept) – Check mapping with audit of files
• Delivery of flow chart to
wards;
• Presentation of information
Wk 8 (30 Sept) - Complete Report & submit to Supervisor
to ward MDT
• Gather feedback . Wk 9 (7 Oct) DU Conference Presentation (Thurs Oct 10th) / Final
◦ Project evaluation: SPEF
• Present to focus group and discipline
Wk 10 (14 Oct) Feedback to IRC Neuro MDT.
specific meetings for feedback.
• Modification to flow chart
Initial Draft Final Draft
Facilitating factors
◦ Partner Ben (prior experience in research).
◦ Knowledge and experience of the IRC staff.
◦ Access to library and Share point at Barwon Health.
◦ Key stakeholders (Melissa Mew, Lidia Davies, Anna McLaren).
◦ Literature search completed prior to placement.
Figure 3 (TJJ,2019)
Barriers
◦ Code yellow
◦ Limited accessibility to computers
◦ Size of the case files
◦ Locations of digital copies of assessments
◦ Availability and accessibility to staff
Figure 5 (Herman & Herman, 2019)
◦ Miscommunication on task delegation
Summary of Findings.
◦ Barwon Health standard of care is in line with national guidelines.
◦ Terms and language used to explain cognition can be affected by region
(Boulanger et al, 2018)
◦ Benchmark of service inline with stroke guidelines 2017.
◦ Only overlap was Abbreviated Mental Test (AMT) by nursing and medical on
day 0.
◦ No allowance for extenuating factors (preference, participation,
interruptions)
◦ Informal communication and assessment cannot be measured.
◦ Inconsistency and confusion of assessment tools being used within disciplines.
Final Evaluation
◦ Roles and scopes of practice were defined.
◦ Easy to follow process map provided.
◦ More time to evaluate work place change and efficiency.
References
◦ Barwon Health. (2019) Cognitive screening and assessment in an inpatient rehabilitation setting:
establishing and implementing evidence-informed practice. Retrieved 14 November 2019.
◦ Herman, M., & Herman, M. (2019). Why You Aren’t Achieving Your Goals - Executive Secretary.
Retrieved 13 November 2019, from [Link]
◦ Steve Kaufmann. (2019). Learn languages online from The Linguist, Retrieved 8 November 2019, from
[Link]
◦ Stroke Foundation (2017). Clinical Guidelines for Stroke Management 2017. Melbourne Australia
[Link]
◦ TJJ,(2019). Retrieved from [Link]
