Improving hospital care
for patients with dementia

A new patient admission assessment system is being tested in a UQ trial.

As Australia’s population ages, health administrators are grappling with ways to manage dementia.

It is now the second leading cause of death in Australia, and there is no cure, making dementia research a global priority.

People with cognitive impairment are at risk of adverse in-hospital events, and poorer outcomes when they are discharged.

They are more likely to experience delirium, suffer falls, have slower recoveries and longer hospital stays - and to die.

But conditions such as dementia can be difficult to identify at admission, as it is often not the primary reason a patient ends up in hospital.

When it is missed, it can lead to serious complications.

Delirium and its associated dangers are more likely.

Knowing a patient has impaired cognition could make a difference to medication choices.

And it highlights the need for hospital staff to confirm information the patient has given them with a family member or carer.

Researchers from UQ’s Centre for Health Services Research are recruiting eight hospitals from across Australia to trial a new patient admission assessment system.

Leading the project is Dr Melinda Martin-Khan, a health scientist focused on improving quality of care and patient outcomes through research with clinicians and consumers.

“For those hospitals participating in the trial, the rewards include a potentially significant improvement in quality of care, particularly for patients with dementia,” Dr Martin-Khan says.

“And this will result in closer alignment with the new National Safety and Quality Health Service standard for comprehensive care.”

The plan is to test the nursing admission assessment system for all adult patients on a hospital-wide basis.

The project is part of the NHMRC Boosting Dementia Research initiative, which aims to accelerate detection, treatment and management of dementia.

Professor Len Gray heads UQ's Centre for Health Services Research.

He has formal training in medicine as a specialist geriatrician and in health administration.

Professor Gray worked in the management of public hospital and specialist aged care services for more than 15 years - and provides valuable insight for the project.

“We know that it is difficult for hospital administrators to look at syndrome-specific solutions, so we’ve come up with a whole-of-hospital solution,” Professor Gray says.

“We are not talking about an additional assessment on top of what hospitals are already doing. This is a new system which has built-in questions to detect cognitive impairment along with other relevant risk assessments.”

Professor Len Gray

The electronic system being trialed is described by researchers as a ‘third generation’ assessment tool.

It takes nurses about 15 minutes to collect admission information on a tablet device.

The system interprets the data entered, and generates a summary report flagging possible risks.

This can be used to guide treatment by multiple stakeholders, including treating and specialist physicians.

The system also enables quality of care to be scored – by patient, ward and hospital.

“Our focus is on helping hospitals to identify what is working – what happens to ensure a patient receives quality care – and to share that information.”

Dr Melinda Martin-Khan

Hospitals in the trial will be invited to form a benchmarking group.

"This will encourage discussion and sharing of information about what hospitals or wards are doing to improve their quality of care,” Dr Martin-Khan says.

Each participating hospital will be asked to implement the system for six months, with assessment to include the cost of transitioning.

The research team is hopeful that it will be permanently adopted in those hospitals, showing that an affordable system good for patients with dementia, will be good for everyone.

This story is featured in the Summer 2017 edition of UQMedicine Magazine. View the latest edition here. Or to listen, watch, or read more stories from UQ’s Faculty of Medicine visit our content hub, MayneStream.