The association between an ultrabrief cognitive screening in older adults and hospital outcomes

BACKGROUND: Though often recommended, hospital cognitive assessment is infrequently completed due to clinical and time constraints. OBJECTIVE: This analysis aimed to evaluate the relationship between performance on ultrabrief cognitive screening instruments and hospital outcomes. DESIGN: This is a secondary data analysis of a quality improvement project. SETTING: Tertiary Veterans Administration hospital in New England. PATIENTS: Patients,≥60 years old, admitted to the hospital. INTERVENTION: None. MEASUREMENTS: Upon admission, patients were administered 2 cognitive screening tools. The modified Richmond Agitation and Sedation Scale (mRASS) is a measure of arousal that can be completed in 15 seconds. The months of the year backward (MOYB) is a measure of attention that can be administered in ≤1 minute. In-hospital outcomes included restraints and mortality, whereas discharge outcomes included length of stay, discharge not home, and variable direct costs. Risk ratios were calculated for dichotomous outcomes and unadjusted Poisson regression for continuous outcomes. RESULTS: Patients (n=3232) were screened. Altered arousal occurred in 15% of patients (n=495); incorrect MOYB was recorded in 45% (n=1457). Relative to those with normal arousal and attention, those with abnormal mRASS and incorrect MOYB had increased length of stay (incident rate ratio [IRR]: 1.23, 95% confidence interval [CI]: 1.17-1.30); restraint use (risk ratio [RR]: 5.05, 95% CI: 3.29-7.75), in-hospital mortality (RR: 3.46, 95% CI: 1.24-9.63), and decreased discharge home (RR: 2.97, 95% CI: 2.42-3.64). Hospital variable direct costs were slightly, but not significantly, higher (IRR: 1.02, 95% CI: 0.88-1.17). CONCLUSION: Impaired performance on ultrabrief cognitive assessments of arousal and attention provide valuable insights regarding hospital outcomes. Journal of Hospital Medicine 2015;10:651-657.