Singing a Song to the Tune of....PROGRESS!!!

            Hello everyone! Well, after a bit of a lull, it has turned out to be a very exciting week in the research world for those of us involved in the UAB ER quality improvement project! And, perhaps most exciting (at least for me anyway), is that I FINALLY gained access to view the electronic medical record system so I’m ready to rock and roll now!

            Before this point, we knew that we needed to measure changes in mental status in elderly patients admitted to the emergency department, we just weren’t sure exactly how to do that because there are so many different screening tools out there, but surprisingly, not a lot of literature on using them especially with elderly patients in an ER setting (which is why our research is so important and groundbreaking J).

            While reading into what little research has already been published about our topic, the main cognitive impairment screening tool that seemed to be used was the Confusion Assessment Method (CAM), but the main problem with this tool is that it is VERY subjective. Another screening tool that has been proven to be tried and true is the Richmond Agitation and Sedation Scale (RASS), but this tool can also be subjective. So, we started looking into more objective tests such as the Six Item Screen (SIS) and the clock-drawing test, which is a very reliable indicator of cognitive impairment. The only problem with the clock drawing test was that there would be no way to enter the results into the electronic medical system that UAB uses, so that screening tool had to be automatically excluded.

            I think our “ah-ha!” moment came after we finally came across an article that directly related to our project (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088375/), and while reading the limitations of the study, we realized that we needed to include both subjective and objective screening tools in our research project to ensure accurate and reliable results. So, we have decided to use the CAM, RASS, and the SIS cognitive screening tools for our project, and we have created a data collection form to record our results of each as well as other important patient information.

            So next week begins my test run of using these three tools congruently! While I am using each one, it will be important for me to time how long it takes me to complete each assessment so that we can see if they would be feasible to perform in a busy ER (and if they are, then the data supporting this will make instituting them an easier sell). This weekend I’ll be busy thoroughly studying how to use each screening method so that by next week I’ll feel comfortable in real-life situations using them and making modifications to our data collection sheet when needed. I do have to say though, that I am a little nervous now that the time has finally come to test our methods…worried I will mess something up or forget to record something, or take too long performing the assessment, or not establish rapport with the patients, or fall in front of a moving stretcher and cause a catastrophe of epic proportions…if you haven’t picked up on my satire, I get extremely nervous before big things like this (and public speaking, eeek!). Let’s pray that Murphy’s Law has no jurisdiction at UAB’s ER!

            As of now, we are one step closer in discovering the most effective way to screen for mental status change at UAB Hospital…and it’s starting with elderly patients in the emergency department! Amid all of this excitement, I had another very important lesson learned this week; sometimes the important thing isn’t having to know which direction you (or your project) is moving in, but more often it’s simply having faith that you (or your project) is moving.

            Look forward to more exciting updates next week as I blog about my first experiences actually implementing our project out in…drumroll please…the real world!