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other·geriatrics, psychiatry, internal medicine, emergency medicine, clinical trial·PMC10040040

Cognitive impairment and behavioural emergencies within the acute hospital setting

BMJ Open Quality · 5 authors, 2 centres

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TL;DR

This mixed-methods study audited the care of hospitalized patients with cognitive impairment and agitation before and after educational interventions for staff.

Full summary

388 CHARS

The study compared 57 Clinical Aggression Response Team (C-ART) calls pre-intervention to 32 post-intervention, following staff education and guideline distribution. Qualitative interviews showed themes of improved staff familiarity, understanding, and communication. A key limitation is the small sample size and the inability to determine if medication use changed in dose or targeting.

STUDY TYPE

other

SPECIALTY

geriatrics

SUMMARISED BY

AI pipeline

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100% · A

ORIGINAL PAPER

PMC10040040

Cognitive impairment and behavioural emergencies within the acute hospital setting

BMJ Open Quality

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ABSTRACT

Abstract Background Patients with cognitive impairment exhibiting agitation and aggression are challenging to manage in the acute hospital setting. When a patient’s behaviours place themselves or others at risk of harm, a Clinical Aggression Response Team (C-ART) is dispatched. The aims of this project were to describe the characteristics of patients receiving a C-ART call and the experiences of C-ART staff members via semistructured interviews. Additionally, to audit local practice against two established standards of practice (Local C-ART Call Guideline and Australian Cognitive Impairment Guideline), to develop interventions to address identified shortfalls in adherence to these standards of practice and finally to re-evaluate adherence postintervention. Methods A retrospective pre and postintervention audit using qualitative (interview) and quantitative (file review) mixed method research approach was used. Interventions targeted doctor hospital orientation sessions, distribution of hospital guidelines including a new pharmacological sedation guideline and finally ward-based brief education sessions. Results Themes identified postintervention included improved familiarity with C-ART terminology, better understanding of C-ART member roles and improved communication among medical teams. However, there was continued pressure to use pharmacological sedation, a lack of debriefing and poor patient handover. File review of patients postintervention showed improvement from 36.8% to 65.6% in recording a provisional diagnosis and differentials for a patient behaviour necessitating a C-ART call. Additionally, the use of psychotropics during C-ART calls was lowered by 3.3% but did not reach significance (p=0.62). Conclusion Behavioural disturbances in the elderly present many challenges for health staff. Interactive orientation sessions for doctors and distribution of hospital guidelines were shown to improve compliance with Local C-ART Call and Australian Cognitive Impairment Guidelines. Patients who receive multiple C-ART calls require further exploration and consideration, as this subset of the patient population present unique challenges. Keywords: Dementia, Geriatrics, Hospital medicine, Patient-centred care, Qualitative research

CITATION EXPORT

Vasko Ilievski, Tomiko Barrett, William Lawson et al.. Cognitive impairment and behavioural emergencies within the acute hospital setting. BMJ Open Quality. (2023). https://doi.org/10.1136/bmjoq-2022-002034

AUTHORS

5 · 2 CENTRES

Vasko Ilievski, Tomiko Barrett, William Lawson, Shane Hoyland, Kelvin Tran

1Department of Geriatrics, Central Coast Local Health District, Hamlyn Terrace, New South Wales, Australia
2Central Coast Local Health District, Hamlyn Terrace, New South Wales, Australia