Standardizing Identification of Cognitive Impairment in the Acute Hospital Setting: Toward a Common Language

Erin Sim; Kelly Casey; Annette Lavezza; Erik Hoyer; Marybeth Moscirella; Nicole Rosenbaum; Michael Friedman; Daniel L Young

doi:10.5014/ajot.2024.050679

Standardizing Identification of Cognitive Impairment in the Acute Hospital Setting: Toward a Common Language

Am J Occup Ther. 2024 Nov 1;78(6):7806205090. doi: 10.5014/ajot.2024.050679.

Authors

Erin Sim¹, Kelly Casey², Annette Lavezza³, Erik Hoyer⁴, Marybeth Moscirella⁵, Nicole Rosenbaum⁶, Michael Friedman⁷, Daniel L Young⁸

Affiliations

¹ Erin Sim, OTD, OTR/L, PMP, is Team Coordinator, Acute Care Therapy Department, Johns Hopkins Hospital, Baltimore, MD; [email protected].
² Kelly Casey, OTD, OTR/L, BCPR, ATP, CPAM, is Rehabilitation Therapy Manager, Acute Care Therapy Department, Johns Hopkins Hospital, Baltimore, MD.
³ Annette Lavezza, OTR/L, is Director, Inpatient Therapy Services, Johns Hopkins Hospital, Baltimore, MD, and Assistant Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.
⁴ Erik Hoyer, MD, is Assistant Professor and Vice Chair for Quality and Safety, Department of Physical Medicine and Rehabilitation, and Member, Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD.
⁵ Marybeth Moscirella, OTD, OTR/L, BCPR, is Occupational Therapist II, Acute Care Therapy Department, Johns Hopkins Hospital, Baltimore, MD.
⁶ Nicole Rosenbaum, OTD, OTR/L, CPAM, is Occupational Therapist II, Acute Care Therapy Department, Johns Hopkins Hospital, Baltimore, MD.
⁷ Michael Friedman, PT, MBA, is Senior Director of Strategic Programs, Johns Hopkins Hospital, Baltimore, MD.
⁸ Daniel L. Young, PT, DPT, PhD, is Associate Professor, Department of Physical Therapy, University of Nevada, Las Vegas; Member, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University School of Medicine, Baltimore, MD; and Adjunct Associate Professor, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.

PMID: 39405413
DOI: 10.5014/ajot.2024.050679

Abstract

Importance: Although many hospitals universally screen their patients for functional mobility and activity impairment, there is no common method to do this for cognitive impairment. Establishing an interdisciplinary and standardized process to screen for cognitive impairment is essential for early identification of impairments, optimization of patients' function, and safe discharge planning. Previously, the reliability and validity of the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) were measured among occupational therapy practitioners and speech-language pathologists; however, its reliability among other team members, specifically nurses, is unknown. This study reports the interprofessional interrater reliability of the AM-PAC ACISF in the acute care hospital setting.

Objective: To examine the nursing-therapist interrater reliability of the AM-PAC ACISF in the acute care hospital setting.

Design: A prospective study using a convenience sample.

Setting: Acute care hospital.

Participants: Fifty adult patients, six nurses, five occupational therapy practitioners, and one speech-language pathologist.

Outcomes and measures: Interrater reliability for the AM-PAC ACISF among therapists and nurses.

Results: Interrater reliability was good among nurses and therapists, with an intraclass correlation coefficient of .88 (95% confidence interval [.79, .93]) for the AM-PAC ACISF.

Conclusions and relevance: Findings suggest that the AM-PAC ACISF is reliable for use among interdisciplinary teams, helps to establish a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting. Plain-Language Summary: Having an interdisciplinary and standardized process to screen patients early for cognitive impairment is essential for identifying impairments, optimizing patients' function, and facilitating safe discharge planning in the acute care setting. Early identification of cognitive impairment by the interdisciplinary team can also allow for timely occupational therapy and other rehabilitation service interventions. The findings of this study suggest that the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) can reliably be used by interdisciplinary teams, establishes a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting.

MeSH terms

Adult
Aged
Cognitive Dysfunction* / diagnosis
Female
Humans
Male
Middle Aged
Observer Variation
Occupational Therapy* / methods
Occupational Therapy* / standards
Prospective Studies
Reproducibility of Results
Speech-Language Pathology