• Andrea M Yevchak, Kelly Doherty, Elizabeth G Archambault, Brittany Kelly, Jennifer R Fonda, and James L Rudolph.
• College of Nursing, The Pennsylvania State University, University Park, Pennsylvania.
• J Hosp Med. 2015 Oct 1; 10 (10): 651-7.

BackgroundThough often recommended, hospital cognitive assessment is infrequently completed due to clinical and time constraints.ObjectiveThis analysis aimed to evaluate the relationship between performance on ultrabrief cognitive screening instruments and hospital outcomes.DesignThis is a secondary data analysis of a quality improvement project.SettingTertiary Veterans Administration hospital in New England.PatientsPatients, ≥ 60 years old, admitted to the hospital.InterventionNone.MeasurementsUpon admission, patients were administered 2 cognitive screening tools. The modified Richmond Agitation and Sedation Scale (mRASS) is a measure of arousal that can be completed in 15 seconds. The months of the year backward (MOYB) is a measure of attention that can be administered in ≤1 minute. In-hospital outcomes included restraints and mortality, whereas discharge outcomes included length of stay, discharge not home, and variable direct costs. Risk ratios were calculated for dichotomous outcomes and unadjusted Poisson regression for continuous outcomes.ResultsPatients (n = 3232) were screened. Altered arousal occurred in 15% of patients (n = 495); incorrect MOYB was recorded in 45% (n = 1457). Relative to those with normal arousal and attention, those with abnormal mRASS and incorrect MOYB had increased length of stay (incident rate ratio [IRR]: 1.23, 95% confidence interval [CI]: 1.17-1.30); restraint use (risk ratio [RR]: 5.05, 95% CI: 3.29-7.75), in-hospital mortality (RR: 3.46, 95% CI: 1.24-9.63), and decreased discharge home (RR: 2.97, 95% CI: 2.42-3.64). Hospital variable direct costs were slightly, but not significantly, higher (IRR: 1.02, 95% CI: 0.88-1.17).ConclusionImpaired performance on ultrabrief cognitive assessments of arousal and attention provide valuable insights regarding hospital outcomes.© 2015 Society of Hospital Medicine.

39 keywords...

hide…