Feasibility of an Online Cognitive Screening Tool to Reduce Postoperative Decline

Abstract

Reduced cognitive function is the most common surgical complication in older adult patients, increasing risks of morbidity and mortality due to functional limitations resulting in complications such as subsequent pneumonia, decubiti, and deep vein thrombosis. Evidence suggests anesthesia providers performing cognitive screening during the preoperative evaluation can prevent 40% of cases involving postoperative cognitive decline (POCD). Despite risks associated with POCD and recommendation for screening, establishing a cognitive baseline in the geriatric surgical population is not routinely performed as part of the preoperative evaluation. The purpose of this quality improvement project was to assess perceived feasibility for integrating an online cognitive screening tool within the preoperative assessment, as well as its potential as an aid for anesthesia providers to develop an individualized anesthetic plan to reduce POCD outcomes. Using a quality improvement design, seven registered nurse anesthetists and three physician anesthesiologists were asked to provide feedback on a survey questionnaire following an educational intervention. The intervention provided information regarding the significance of cognitive decline following surgery in older adult patients and the projected increases in the elderly population over the next 30 years. The anesthesia providers were introduced to an online cognitive screening tool and evidence validating its use, and clinical guideline recommendations regarding common anesthetic drug use in older adult patients were reviewed. Survey questions were developed to assess whether the proposed intervention was feasible, appropriate, meaningful, and effective within the contexts of their organization. The intent of this project was to assess whether anesthesia providers perceive an online cognitive screening tool to be feasible for enhancing communication between patients and providers, identifying at-risk patients for cognitive decline, and whether an at-risk score would influence anesthetic agent selection. Overall, anesthesia providers surveyed find the idea of using an online cognitive screening tool appealing, and perceive its use for cognitive screening as potentially effective for improving surgical outcomes, as well as consistent with patient and provider values concerning postoperative outcomes. Therefore, implementing an online cognitive screening tool as part of the preoperative evaluation may be a valuable solution towards implementing and adopting routine baseline cognitive screening for geriatric surgical patients.