Project Overview
Project Description: Occupational therapy (OT) practitioners in the acute care setting evaluate and treat a diverse range of patient populations, thus requiring a vast knowledge of conditions and symptoms to serve each patient accurately. At Ball Memorial Hospital (BMH), there are competencies in critical care, in-line suctioning, and oxygen management for occupational therapy practitioners to ensure quality care. Administering cognitive screens and assessments is an area where OT practitioners are not thoroughly educated at BMH. This project aims to increase clinician competence and confidence in utilizing cognitive assessments and screens to reduce readmission rates in the acute care setting with increased discharge accuracy and provide patient education resources for increased safety.
Project Site: IU Health Ball Memorial Hospital
Topic Areas: (1) Program and Policy Development (2) Education
Area of Practice: Evidence-Based Practice & Research
Mentors
Expert Mentor: Sara Gulde, MOT, OTR
Faculty Mentor: Jill Linder, DHSc, OTR, CBIS, CSRS
Needs Assessment
- Requests from Ball Memorial education and compliance coordinator for OT practitioner competency addressing cognitive assessments
- Expressed concern from site on insurance companies not approving of some recommended discharge locations due to lack of standardized assessment scores
- Decreased clinician knowledge of cognitive assessments especially, functional assessments
- Increased patient readmission rates due to falls within the first month following a hospital discharge (Mahoney et al., 2000)
Literature Review
- Research supports occupational therapy intervention in reducing hospital readmission rates (Lockwood & Porter, 2022; Roberts, 2020).
- Insurances companies may require standardized assessments to substantiate funding for additional OT services (Sorensen et al., 2020). This is more prevalent in patient cases where cognitive deficits are present versus functional deficits.
- Physicians often overlook identifying mild cognitive impairments (MCI) due to poor understanding of MCI (Blair et al., 2022). Acute care OTs use assessments to gather additional insight into patient deficits such as an MCI not provided by observations or informal interviews.
- Research supports cognitive screening tools in acute and their predictor of post-discharge functioning.
Project Outcomes
Outcomes for the project include 5 deliverables
Deliverable #1: Written Competency Proposal
Deliverable #2: Certificate of Completion of Fall Prevention and Social Determinants of Health CEU Course
Deliverable #3: Certificate of Completion of Discharge Planning Part 1: Introduction into Acute Care CEU Course
Deliverable #4: Action Plan for Creating Patient Education Materials
Deliverable #5: Copies of Completed Patient Safety Handouts
Additional Project Outcomes
Prior to distributing the competency, OT practitioners attended an in-service on cognitive assessments and screening tools. Practitioners also received a resource folder for evidence-based assessments and screens that included the assessment or screen itself, scoring criteria, and documentation examples. In addition, OT received access to online functional cognition intervention ideas to be utilized in either acute care or inpatient rehab.
Project Impact
The aim for this project is continued implementation of the cognitive assessment and screens competency for all occupational therapy practitioners at Ball Memorial through collaboration with the education and compliance coordinator. OTs will have access to cognition resources in order to properly evaluate and treat cognitive deficits. I am hopeful for the sustainability of the competency I created and the administration of cognitive assessments.
Contact Information
References
Blair, E. M., Zahuranec, D. B., Forman, J., Reale, B. K., Langa, K. M., Giordani, B., Fagerlin, A., Kollman, C., Whitney, R. T., & Levine, D. A. (2022). Physician diagnosis and knowledge of mild cognitive impairment. Journal of Alzheimer’s Disease : JAD, 85(1), 273–282. https://doi.org/10.3233/JAD-210565
Lockwood, K. & Porter, J. (2022). Effectiveness of hospital-based interventions by occupational therapy practitioners on reducing readmissions: a systematic review with meta-analyses. American Journal of Occupational Therapy, 76. https:/doi.org/10.5014/ajot.2022.048959
Photo retrieved from: https://www.apta.org/your-practice/practice-models-and-settings/hospitals
Roberts, P., Robinson, M., Furniss, J., & Metzler, C. (2020). Occupational therapy's value in provision of quality care to prevent readmissions. American Journal of Occupational Therapy, 74(3). https://doi.org/10.5014/ajot.2020.743002
Sorensen, M., Sercy, E., Salottolo, K., Waxman, M., West, T. A., Tanner II, A., & Bar-Or, D. (2020). The effect of discharge destination and primary insurance provider on hospital discharge delay among patients with traumatic brain injury: a multicenter study of 1,543 patients. Patient Safety in Surgery, 14(2). https://doi.org/10.1186/s13037-019-0227-z