Identification and information management of cognitive impairment of patients in acute care hospitals: An integrative review

Beibei Xiong; Daniel X Bailey; Paul Prudon; Elaine M Pascoe; Leonard C Gray; Frederick Graham; Amanda Henderson; Melinda Martin-Khan

doi:10.1016/j.ijnss.2023.11.001

Identification and information management of cognitive impairment of patients in acute care hospitals: An integrative review

Int J Nurs Sci. 2023 Dec 1;11(1):120-132. doi: 10.1016/j.ijnss.2023.11.001. eCollection 2024 Jan.

Authors

Beibei Xiong¹, Daniel X Bailey^{1

2}, Paul Prudon¹, Elaine M Pascoe¹, Leonard C Gray¹, Frederick Graham^{1

3

4}, Amanda Henderson^{1

5

6

7

8}, Melinda Martin-Khan^{1

9

10}

Affiliations

¹ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
² Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women's Hospital, Brisbane, Australia.
³ Dementia and Delirium, Division of Medicine, Princess Alexandra Hospital, Brisbane, Australia.
⁴ School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
⁵ Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Australia.
⁶ School of Nursing, Midwifery and Social Sciences, Central Queensland University, Brisbane, Australia.
⁷ Griffith Health, Griffith University, Brisbane, Australia.
⁸ School of Nursing, Midwifery and Paramedicine, The University of the Sunshine Coast, Brisbane, Australia.
⁹ Department of Health and Life Sciences, University of Exeter, Exeter, United Kingdom.
¹⁰ School of Nursing, University of Northern British Columbia, Prince George, Canada.

Abstract

Objectives: Recognition of the cognitive status of patients is important so that care can be tailored accordingly. The objective of this integrative review was to report on the current practices that acute care hospitals use to identify people with cognitive impairment and how information about cognition is managed within the healthcare record as well as the approaches required and recommended by policies.

Methods: Following Whittemore & Knafl's five-step method, we systematically searched Medline, CINAHL, and Scopus databases and various grey literature sources. Articles relevant to the programs that have been implemented in acute care hospitals regarding the identification of cognitive impairment and management of cognition information were included. The Mixed Methods Appraisal Tool and AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) Checklist were used to evaluate the quality of the studies. Thematic analysis was used to present and synthesise results. This review was pre-registered on PROSPERO ( CRD42022343577).

Results: Twenty-two primary studies and ten government/industry publications were included in the analysis. Findings included gaps between practice and policy. Although identification of cognitive impairment, transparency of cognition information, and interaction with patients, families, and carers (if appropriate) about this condition were highly valued at a policy level, sometimes in practice, cognitive assessments were informal, patient cognition information was not recorded, and interactions with patients, families, and carers were lacking.

Discussion: By incorporating cognitive assessment, developing an integrated information management system using information technology, establishing relevant laws and regulations, providing education and training, and adopting a national approach, significant improvements can be made in the care provided to individuals with cognitive impairment.

Keywords: Acute care; Cognitive dysfunction; Data transparency; Delirium; Dementia; Health information management; Patient interaction.

Publication types

Review