The impact of the Dementia Care in Hospitals Program in improving the quality of life and adverse events in acute hospital patients with cognitive impairment: A stepped wedge cluster trial

Dementia was the third leading cause of death in 2010, with 9,003 deaths recorded across Australia. For people aged 65 and over, dementia was the second leading cause of burden of disease and the leading cause of disability burden. Dementia is now the ninth National Health Priority Area in Australia. Bail et al. (personal communication) from the Hospital dementia Services Project (2012) indicates that patient with dementia in medical and surgical services have 2.5 times increased risk of adverse event compared to the no dementia group matched for age and other comorbidities. In the acute hospital setting patients can have difficulties with memory and thinking because of dementia or for other reasons such as delirium or specific brain injury such as stroke. Irrespective of the cause, disorders of memory and thinking or more succinctly Cognitive Impairment (CI) are a source of risk in the complex hospital environment. While dementia can also occur in younger people, the current study will focus on patients in acute hospitals aged 65 and over with cognitive impairment as this is the largest hospital group. Rationale for study: It is recognised that hospital staff are not adequately equipped to identify or respond appropriately to people with dementia. The Dementia Care in Hospitals Program (DCHP) is an all of hospital education program to improve communication with and awareness of patients with Cognitive Impairment (CI) linked to a bedside alert: the cognitive impairment identifier (CII). This program was first developed and introduced at BHS in 2004 in partnership with people with dementia and their families. The DCHP has been adopted by 25 public and private hospitals in Victoria. The program involves comprehensive training for clinical and non-clinical hospital staff. Unpublished evaluations of the program found that 80% of staff reported it improved their practice and 40% reported that it had improved their response to carers. Carers also reported greater satisfaction with the care their family member received (AIHW 2013). However, while staff perceptions and carer and patient satisfaction were measured, the effect of the DCHP on clinical outcomes such as adverse events and cost effectiveness has not been measured. The Department of Social Services has now funded a roll-out of the DCHP to other Australian jurisdictions and requested a national evaluation which is the basis for this study. There are three interrelated but separate elements to the evaluation that is the subject of this protocol- 1. Change in patient quality of life, carer satisfaction and staff knowledge and perceived difficulty with care 2. Change in nursing modifiable adverse events in patients over 65 with cognitive impairment 3. Cost effectiveness of the DCHP Element (2) is the basis for a PhD to be completed by A/Prof Mark Yates