Implementing a Cognitive Aid for Ward Rounds for Older Patients With Frailty: Lessons Learned and Future Directions

Ward rounds are essential to clinical practice, yet structured training for residents remains limited in managing older patients with frailty. This feasibility study explored the implementation of a cognitive aid and examined the experiences of residents, patients and caregivers.

A controlled before-and-after study of Internal Medicine residents was conducted in a teaching hospital, introducing the cognitive aid to the intervention group through lectures, simulation sessions and podcasts. Implementation was documented through field notes. Residents' use and acceptability of the aid were assessed through self-reported data and video ratings by independent, blinded raters, using a 7-point Likert scale. Patient and caregiver perspectives were gathered through interviews and surveys.

Fourteen residents participated, achieving a median rating of 5 out of 7 on cognitive aid items, with no difference between groups. All intervention group participants attended the lecture and simulation, but podcast usage was modest. Self-reported non-use was attributed to aid density, insufficient feedback and a limited perceived need for behavioural change. Patients expressed satisfaction with ward rounds but often hesitated to provide genuine feedback, attributing communication difficulties to themselves, such as language barriers. Caregivers were present during 3 of the 28 ward rounds.

The intervention was only partially delivered, and the cognitive aid was not used in practice. Residents found it too complex and lacked follow-up. Patient feedback was characterised by deference and self-blame, and caregiver input remained minimal. Future efforts must streamline the aid, embed training into supervision and rethink how feedback from patients and caregivers is collected.