The utility of neuropsychological consultation in identifying medical inpatients with suspected cognitive impairment at risk for greater hospital utilization

Sieg, Erica; Mai, Quan; Mosti, Caterina; Brook, Michael A.

doi:10.1080/13854046.2018.1465124

Cited by 8 publications

(5 citation statements)

References 26 publications

(31 reference statements)

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“…Growing evidence that performance measures of cognition (including EF) contribute to glycemic control, and that diabetes itself has a deleterious impact on cognition (36), suggest that neuropsychological evaluations may be beneficial in identifying those who are at risk for poor health outcomes. Such evaluations, together with tailored feedback, have been associated with improved patient outcomes in a variety of settings (37).…”

Section: Discussionmentioning

confidence: 99%

Executive Function Predicting Longitudinal Change in Type 1 Diabetes Management During the Transition to Emerging Adulthood

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Executive Function Predicting Longitudinal Change in Type 1 Diabetes Management During the Transition to Emerging Adulthood

et al. 2018

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“…However, cognitive functioning via formal neuropsychological assessment in inpatient settings is rarely obtained [17]. Neuropsychological testing is an underutilized resource within inpatient facilities due to cost, length of the test battery, and a limited number of neuropsychologists within these settings [36]. Implementing a neuropsychological screener can help identify deficits that may interfere with a patient's ability to adhere to a treatment plan, monitor medications, or actively participate in treatment programs; factors that are associated with readmission rates.…”

Section: Study Purpose and Rationalementioning

confidence: 99%

“…Increased emphasis and attention in psychiatric research have yielded more evidence to the neurobiology of cognition; especially in Schizophrenia, Bipolar Disorder, and Post Traumatic Stress Disorder [36]. Although many psychiatric clinicians are trained in cognitive assessments, such as the "clock test," "serial sevens," "numbers forward and backward," "proverb," and "word recall," in addition to common scenarios to evaluate judgment and insight, such as "mailing a letter," they are typically not completed during a standard psychiatric evaluation due to time limitations and high volume in the unit setting [36]. Neuropsychological testing can help to pinpoint cognitive deficits that interfere with intervention and the potential for optimal patient outcomes [37][38][39][40].…”

Section: Study Purpose and Rationalementioning

confidence: 99%

The Relationship between Cognitive Impairment in Psychiatric Patients and Readmission Rate to an Inpatient Facility

Isis Schuff,

J Aragon

2023

J Clin Psychol Neurol

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The primary intention of this study was to further understand the impact of assessing cognitive impairment in psychiatric patients, as a mediating factor on readmission rates. Mild cognitive dysfunction impacts a patient’s functional outcomes [1,2]. Little information exists to guide best practices in the treatment of adults with cognitive impairment who are hospitalized for acute conditions [2]. A cognitive impairment may impact patient prognosis and ability to function outside of a setting focused on stabilization. Neuropsychological testing is a valuable tool in predicting a patient’s cognitive potential. However, creating a battery of tests that must be short enough to fit the needs of patients within an inpatient setting, allowing them to demonstrate their ability, while still providing enough information for accurate diagnosis and prognosis is a challenge. Overall, this study aimed to investigate the utilization of brief cognitive screeners in identifying patients that may be more vulnerable to relapse and readmission. Cognitive impairment was assessed utilizing the Montreal Cognitive Assessment (MoCA). Readmission rate is defined by total admissions per individual patient. The use of community resources, such as medication management, case management, housing programs, and their relationship with readmission rates was examined. Archival data was taken from an inpatient facility’s HIPAA-compliant electronic medical record (EMR) database. All personal identifying information was de-identified to ensure minimal risk of breaching confidentiality. Although all objectives demonstrated significant correlations among the variables, there were no significant predictive models. This study found a positive linear relationship between admission rate and a higher MoCA score. This may partially be explained by Age (M = 69.09, SD = 8.25) having a negative relationship with inpatient readmission rate and a positive relationship with community resources. Within the inpatient setting, patients with higher cognitive functioning may be more aware of their mental health symptoms and are more likely to seek help. This may lead to more frequent admissions as they are able to seek help to address their mental health concerns. The relationship between patient demographics, community resource usage, and readmission rate was also examined. Limitations of this study included the use of archival data, a small sample size, and a lack of diversity within the sample. Future directions for research include norming the MoCA for psychiatric populations and examining deficit patterns within the cognitive domains.

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“…Based on the Hardy et al approach, targeted screening (and universal monitoring) in the context of inpatient hospital settings has the potential to be effective in contributing to patient care and has already demonstrated utility in adult populations (Bishop et al, 2003; Sieg et al, 2019). According to existing literature, most referrals for inpatient assessment tend to be patients who have conditions that directly impact the central nervous system, such as traumatic brain injury, seizure, stroke, and brain tumor (Yeates, 1995).…”

Section: Targeted Neuropsychological Screening On C/l Servicesmentioning

confidence: 99%

“…Space was not a significant barrier to test completion (Khetani et al, 2018), and noise-canceling headphones mitigated noise concerns. Findings from the adult C/L literature also suggest that adults referred for bedside neuropsychological evaluations demonstrate lower future health care utilization, including lower incidence and shorter length of hospitalization, fewer ED visits, and lower cost of hospitalization one year after discharge (Sieg et al, 2019; Vankirk et al, 2013). Further research is needed in pediatrics to determine if similar relationships exist in children.…”

Section: Utility and Feasibility Of Neurocognitive Assessmentmentioning

confidence: 99%

Targeted neuropsychological screening in the context of a pediatric psychiatry consultation/liaison service.

Bush¹,

Ohanian²,

Drossos³

et al. 2022

Clinical Practice in Pediatric Psychology

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Objective: Inpatient neuropsychological screening represents a promising direction for addressing consultation questions directed to pediatric psychiatry consultation/liaison (C/L) providers. Despite the potential of such a service, few studies have directly examined the role of targeted neuropsychological screening on a pediatric psychiatry C/L team. Thus, the primary goals of this paper were to explore the feasibility and utility of brief neuropsychological assessment in the context of a C/L service. Method: We review the literature related to neuropsychological consultation in pediatric medical settings. We provide a clinical case example to illustrate our experience incorporating targeted neuropsychological screening on our pediatric psychiatry C/L service. Results: Targeted screening as part of a psychiatry consultation service has the potential to be informative in patient care. Several existing preventive pediatric care models that include brief assessment are already being used in other pediatric medical settings. Conclusions: Inpatient neuropsychological screening can play a role in integrated care teams when both its strengths and limitations are understood. The incorporation of brief neuropsychological assessment into clinical practice within C/L services represents an important and potentially impactful future direction in both research and clinical care. Implications for Impact StatementNeuropsychological screening as part of a psychiatry consultation service has the potential to be informative for patient care. There are many existing preventive pediatric care models that include brief assessment in other medical settings. This paper reviews the relevant literature and provides a clinical case example to illustrate this.

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The utility of neuropsychological consultation in identifying medical inpatients with suspected cognitive impairment at risk for greater hospital utilization

Cited by 8 publications

References 26 publications

Executive Function Predicting Longitudinal Change in Type 1 Diabetes Management During the Transition to Emerging Adulthood

Executive Function Predicting Longitudinal Change in Type 1 Diabetes Management During the Transition to Emerging Adulthood

The Relationship between Cognitive Impairment in Psychiatric Patients and Readmission Rate to an Inpatient Facility

Targeted neuropsychological screening in the context of a pediatric psychiatry consultation/liaison service.

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