Improving Adherence to Perioperative Cognitive Assessment Documentation in Hip Fracture Patients: A Quality...

Background Perioperative cognitive assessments are recommended by the National Institute for Health and Care Excellence (NICE) for all hip fracture patients as part of best practice tariffs. The Abbreviated Mental Test Score (AMTS) and 4A's Test (4AT) are widely used tools for cognitive assessments. This quality improvement project aimed to assess and improve adherence to AMTS and 4AT documentation protocols in hip fracture patients within our department. Method Two prospective audits were conducted on all inpatients with hip fractures in our department between April and July 2024. Data on patient demographics, adherence to AMTS and 4AT documentation protocols, and the presence of postoperative delirium were collected. Admission AMTS was defined as the documentation of AMTS within 24 hours of the patient's presentation to the emergency department. Educational posters were displayed in clinical areas as part of a targeted intervention between each audit cycle. Results A total of 49 patients were identified across both cycles, with 19 in the first cycle and 30 in the second. About 15 (78.9%) patients had an admission AMTS documented by the admitting doctor or orthogeriatric team. About 18 (94.7%) patients had a documented postoperative AMTS, but only nine (47.4%) had a postoperative 4AT documented. No patients developed postoperative delirium during the first cycle. Following our educational initiatives, 29 (96.7%) patients had a documented admission AMTS. Postoperatively, AMTS and 4AT documentation were present in 26 (86.7%) and 18 (60.0%) patients, respectively. Six (20.0%) patients developed postoperative delirium in the second cycle. Conclusion This quality improvement project highlights the importance of staff education in improving adherence to documentation. However, complete adherence has not yet been achieved. The presence of postoperative delirium in a significant number of patients emphasizes the importance of prompt cognitive assessment to improve patient outcomes in this vulnerable cohort. Further efforts should identify barriers to the consistent assessment and documentation of AMTS and 4AT scores.