Improving the uptake and comprehensiveness of bedside cognitive testing amongst liaison psychiatrists over an eight-month period.
Bibliographic record
Abstract
The aim of this quality improvement (QI) project was to improve the uptake and comprehensiveness of bedside cognitive testing amongst liaison psychiatrists over an eight month period. The baseline measurement involved an audit of the practice of the neuropsychiatry liaison team over six months at the 840 bed St Thomas's Hospital in London, UK. Of 35 referrals, 21 patients were able, and suitable, for cognitive testing based on the referral data and clinical interview. Fourteen (66.6%) of these patients had an Addenbrooke's Cognitive Examination (ACE), while 5 (23.8%) had frontal testing. The frontal tests performed were variable and inconsistent. Two Plan-Do-Study-Act (PDSA) cycles were then conducted. Clear guidance was issued to the team on the use of the ACE or Montreal Cognitive Assessment (MoCA) in suitable patients, and how these can be supplemented by frontal testing. Given the inconsistency in the types and combination of frontal tests being conducted at baseline, a frontal lobe test sheet containing established tests was developed and implemented. In PDSA cycle 1, 100% (n=10) of able and suitable referrals had an ACE or MoCA while 100% had frontal testing (80% of these using the dedicated test sheet). In PDSA cycle 2, improvements were broadly maintained with 85.7% (n=6) of referrals having an ACE/MoCA and 85.7% having frontal testing (83.3% of these using the dedicated frontal test sheet). In conclusion, our team improved the uptake and comprehensiveness of bedside cognitive testing by changing existing practice with clear protocols regarding the use of the ACE/MoCA and the implementation of a frontal test sheet.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".