Evaluating Quality of Care Project

Overview

The Evaluating Quality of Care (eQC) project, which commenced in 2018, is a five-year project led by Dr Melinda Martin-Khan and Professor Len Gray. The Patient and Carer Advisory Board was established to partner with the eQC Project investigators and provide a lived experience perspective of people living with cognitive impairment and their carers who interact with hospital services.

The eQC Project has a goal to enhance the quality of care provided to patients with cognitive impairment who are admitted to hospitals. Many elderly patients face various health challenges, including cognitive problems like confusion and memory loss, which can hinder both their recovery from illnesses and to contribute to planning their own care. Research demonstrates that when cognitive impairment is overlooked or not taken into account when establishing and actioning a patient's care plan, their likelihood of experiencing negative health outcomes increases. Regrettably, hospitals often fail to adequately identify these cognitive issues and incorporate them effectively into treatment planning and communication with patients and care partners. In some instances, these issues may not even be assessed, with hospitals primarily focusing on addressing the immediate health concern that led to the admission. Consequently, this can result in complications and higher financial and health burdens for both the patient and their family.

eQC Project aims

Show how involving patients and the public in research can improve the quality of care for people with dementia in hospitals.
Explain how hospitals record and share information about a patient's cognitive abilities, and how healthcare professionals use this information to provide care.
Explore the care and support provided to people with dementia in hospitals after the adoption of the Comprehensive Care Standard by the Australian Commission on Safety and Quality in Healthcare.
Investigate how organizations introduce new digital systems and assess their effectiveness.
Provide information on how common occupational violence is in hospitals and the contributing factors.

Patient and Public Involvement in Medical Research

Patient and public involvement (PPI) in research is an active partnership between patients/public and researchers in the research process. It is distinct from people taking part in research studies as participants. Rather, it is members of the public being contributing to research as an integral part of the research team.

Public contributors include patients, potential patients, carers, as well as people from organisations that represent people who use health or social care services. There are many terms for public contributors such as public representatives, lived experience experts, consumers, patient advocates, lay researchers, public partners, and others.

The Board is committed to continually improving and developing its approach to productive and equitable patient and public involvement and is committed to working in collaboration with researchers to develop processes which facilitate public involvement in research.

Section 1 is intended to document the actions taken during formation of the Patient and Carer Advisory Board and to evaluate its activities as an advisory body for the project. Public involvement in health research is growing considerably in importance and it is therefore important to evaluate and report processes used to involve members of the public in research so that future efforts can be more effective, equitable, and respectful.

Care of people with Cognitive Impairment (CI) in hospital during the COVID pandemic

Most who contact COVID-19 show mild to moderate symptoms and can recover at home; however, people with cognitive impairment or dementia may encounter challenges should they require hospital care during COVID-19 pandemic restrictions. Hospitals can be challenging, unfamiliar environments, particularly for those with cognitive impairment. Infection control measures implemented during the pandemic, such as the visitor bans which also applied to carers, can lead to escalation of distress and poorer outcomes for patients with cognitive impairment.

Interim guidance documents were created by the Board, eQC researchers, and other stakeholders and experts early in the pandemic. These aimed to assist healthcare professionals in maintaining a high level of quality hospital care for adults with dementia and other cognitive impairments while also limiting the spread of SARS-CoV2. These documents highlight the challenges inherent to caring for patients with cognitive impairment during the pandemic and outline management strategies to address these challenges from clinical and governance levels.

Public-facing resources were also created to provide guidance for patients, carers and families navigating the challenges of a hospital admission. These resources cover how to prepare in advance for a hospital admission, such as having documentation, medication, and personal protective equipment ready, and advice on checking what relevant hospital policies may be in place regarding visitor restrictions for carers and families. Additionally, the public-facing documents also contain information on delirium and distress and how these may be managed by hospital staff in collaboration with patients, carers and families.

While the height of the pandemic has currently passed in Australia, healthcare professionals must still be mindful of the challenges still presented by COVID-19 and work to ensure that hospital care meets the needs of patients. The outputs of this project are currently under review by the Board and eQC researchers for the purposes of modernising the relevant content for use now restrictions have eased.

Recognition of cognitive impairment status in hospital – Current Approach

This study aims to examine the current methods used in Australian healthcare organizations for assessing and sharing cognitive status information with patients and their care partners in acute settings. The research will attempt to determine how hospital patients are informed of their cognitive screening results, how often cognitive screenings are conducted, and whether referrals for further assessments are made after screening. The research will also consider whether staff approach cognitive assessments differently for patients from the community compared to those from residential care.

A literature analysis has been conducted to identify the latest research on recording and informing patients of their cognitive status. Next, interviews and focus groups with hospital staff, patients, and carers will also be held to gain insight into legal, clinical, and personal preferences regarding cognitive status recording in acute care. Ultimately, the research team will recommend protocols to help clarify the preferences of individuals with dementia and their caregivers regarding cognitive status recording in emergency settings.

The impact of the Australian Comprehensive Care Standard on the process of care in acute hospitals with reference for people with dementia

The Australian Commission on Safety and Quality in Healthcare (ACSQHC) has introduced the Comprehensive Care Standard to focus on improving hospital care and patient outcomes. This project will look at how different hospitals are implementing the Standard; what are the barriers and facilitators identified in this process, and how patients' health outcomes are impacted pre and post introduction of the Standard. The study will specifically look at how patients with dementia are affected by the standard and if they are receiving care that meets their needs.

The ACSQHC hopes to gain a better understanding of the challenges faced in implementing the Standard, and the impact on patient care and outcomes. This understanding will help improve organizational policies and practices to better support comprehensive care. Healthcare professionals will also benefit from this study, as it will increase their knowledge and commitment to comprehensive care planning and delivery. This will encourage better collaboration between different care providers to improve care.

Finally, patients and carers will have more tools, resources, and information available to help them be involved in their care planning and decision-making. This will encourage more patients, including those with dementia, to advocate for comprehensive care that meets their needs.

Understanding and managing trust during digital transformation

This project focuses on how hospitals and healthcare institutions can build and maintain trust during the process of implementing digital Assessment and Care planning systems. Research has shown that trust is important for organizational change and digital transformation (going from paper to digital records), as it helps people accept and adapt to new ways of working. However, change can also damage trust, which is a problem in healthcare because patients' trust in healthcare professionals affects their health outcomes.

There has been no comprehensive review of the literature that can guide healthcare institutions on how to build and maintain trust during digital transformation. This project aims to fill that gap by conducting a systematic review of the literature to develop evidence-based strategies for building and maintaining trust during the digital transformation of healthcare institutions.

The contribution of cognitive impairment to occupational violence in hospitals: A retrospective, mixed methods study

In hospital environments, elderly patients, particularly those managing cognitive impairments like dementia, are more susceptible to unfavourable outcomes. These patients often display behavioural changes, such as agitation, depression, and anxiety, which may be a response to the unfamiliar and hectic hospital setting. Importantly, these changes in behaviour are not to be seen as the fault of the patient, but rather a result of the complex interplay between the cognitive condition, unmet needs, and environmental factors. In some instances, these behaviours can escalate, leading to situations involving patient-patient or patient-staff altercations. Despite their rarity, these incidents can have significant consequences, including injuries and the diversion of hospital resources. Currently, the lack of understanding about the precipitating factors of these incidents makes them difficult to anticipate and prevent.

This study aims to investigate the distribution of such incidents among older individuals and those with cognitive impairments in comparison to other patient groups within hospitals. The objective is to identify risk factors that could inform future prevention strategies. The research will be conducted in three phases: the first will analyse the distribution and frequency of these incidents across different ages and wards; the second will investigate potential risk factors that could increase the incidence of these events; and the third will examine detailed incident reports for patients with cognitive impairments to identify specific risk factors and analyse incident severity.