A team of investigators at Cedars-Sinai has developed a method utilizing electronic health records (EHRs) to identify hospitalized patients with dementia. This innovative approach, detailed in a study published in the Journal of the American Geriatrics Society, aims to improve the quality of care provided to individuals with dementia.
According to Dr. Zaldy Tan, the medical director of the Jona Goldrich Center for Alzheimer’s and Memory Disorders at Cedars-Sinai and the study’s first author, patients with dementia or cognitive impairment face significant vulnerabilities during hospitalization if their care team is not aware of their condition. The study is unique in that it explores the feasibility of using EHRs to identify these patients and provide the hospital team with critical information to guide clinical care effectively.
When individuals with dementia are admitted to the hospital for unrelated conditions, such as falls or infections, they may struggle to accurately convey their medical history or make informed decisions about their healthcare. Additionally, patients with dementia often require assistance in understanding discharge instructions and maintaining a sense of calm in the hospital environment.
Unfortunately, diagnoses such as Alzheimer’s disease, dementia, or cognitive impairment are frequently not documented in a patient’s medical records. Dr. Tan, who is also the director of the Memory and Healthy Aging Program and the C.A.R.E.S. Program at Cedars-Sinai, explains that when healthcare providers are unaware of a patient’s dementia, they may neglect to contact a loved one who can provide valuable information, aid in decision-making, and offer emotional support.
To address this issue, the investigators developed a secure algorithm capable of searching patients’ EHRs for dementia diagnoses and prescriptions for FDA-approved dementia medications. Creating the algorithm posed a challenge due to the various clinical scenarios that could potentially lead to a dementia diagnosis. Dr. Cameron Escovedo, the physician leader of Enterprise Information Services at Cedars-Sinai and co-author of the study, emphasizes that the algorithm had to account for these scenarios and ensure that it could accurately capture every patient with potential dementia.
When the algorithm identifies a patient with possible dementia, a yellow banner appears on the patient’s chart, alerting the hospital staff of the condition. This flagging system is crucial because current dementia care in hospitals often results in poor patient outcomes. These outcomes include an increased risk of falls, the use of restraints, and the prescription of antipsychotic medications. By notifying the hospital team about the presence of cognitive impairment, the algorithm enables them to implement targeted interventions and improve outcomes for vulnerable hospitalized patients, as stated by Dr. Nancy Sicotte, the chair of the Department of Neurology at Cedars-Sinai and senior author of the study.
To ensure that medical staff understands how to respond to dementia patients once they are identified, a team of nurses and physicians at Cedars-Sinai created and tested a training program, the results of which were published in the journal Geriatric Nursing. The training program, conducted through multiple virtual sessions led by nurse practitioners Deana Rhinehart and Dyane Gatmaitan, focuses on topics such as effective communication, behavioral documentation, differentiating between delirium and dementia, medication refusal, behavior management, and patient advocacy.
In the units where the training was implemented, about 25% of the nursing staff felt that they had not previously received comprehensive training in dementia care. The goal of the program was to bridge the knowledge and confidence gap among nursing teams. Rhinehart and Gatmaitan are currently finalizing a plan to expand the training to additional units in March.
Dr. Tan states that the identification system will be expanded to all medical and some surgical units. Furthermore, both the system and the training program, currently in use only at Cedars-Sinai, can be easily implemented in other healthcare institutions to improve the care provided to patients with dementia.
1. Source: Coherent Market Insights, Public sources, Desk research
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