Evidence-base: It is estimated that up to a quarter of cases of the 700,000 people suffering with dementia in the United Kingdom are still undiagnosed. The recent introduction of the national commissioning for quality and innovation (CQUIN) for dementia aims to promote improved screening for dementia of patients over 75 years of age admitted to secondary care and to ensure a subsequent comprehensive assessment and referral to specialist services where appropriate for all cases of cognitive decline.
Change strategies: Following an initial audit, a DDA tool was introduced into the standard admission proforma for the hospital, with the aim to facilitate the identification of possible cognitive decline on admission with subsequent assessment and referral of appropriate patients.
A re-audit was performed comparing the results of 34 patients admitted to the elderly short stay unit prior to the DDA tool implementation, to 33 patients admitted to the same unit following implementation. The data was collected retrospectively using case note retrieval.
Change Effects: Prior to the implementation of the DDA tool, only 82% were screened for cognitive decline compared to 94% after implementation. Of identified patients requiring further assessment, only 37% had a complete assessment compared to 55% after the tool was introduced. For those patients with no organic cause attributed to their cognitive decline with suspected dementia diagnoses, 11% were appropriately referred before use of the tool and 52% after.
Conclusion: Overall the implementation of the DDA tool has improved performance in screening patients for dementia over 75 admitted to secondary care with subsequent complete assessment and referral for appropriate patients. Additional developments to the DDA tool are being employed to improve functionality, alongside a dementia awareness campaign with recruitment of dementia champions and targeted training for involved staff. We intend to complete a further audit cycle in one year.