NOTICE-ED: Nurse or Technician Insights Into Cognitive Evaluations in the Emergency Department

Abstract

Background

Several strategies have been proposed to increase chronic cognitive impairment (CI) screening in the emergency department (ED). Our goal was to assess the feasibility and acceptability of implementing specific CI screening tools and strategies in the ED from an ED registered nurse and technician perspective.

Methods

We performed a qualitative study using semi-structured interviews with a purposive sample of ED nurses and ED technicians (EDTs). Participants worked at an urban academic hospital and were interviewed between November 2023 and March 2024. Interviews assessed participants' opinions on the feasibility and acceptability of CI screening and the use of machine learning (ML) tools to identify high-risk patients for targeted CI screening, tablet-based screenings, and two validated CI screenings: the Ottawa 3DY (O3DY) and Short Blessed Test (SBT). We used the Consolidated Framework for Implementation Research (CFIR) to develop our interview guide and performed a rapid analysis with deductive and inductive codes based on CFIR constructs.

Results

Four major themes related to CI screening tools arose: (1) Benefits of CI screening; (2) feasibility of integrating screening tools into existing workflows; (3) professional role limitations; and (4) implementation requirements. Participants perceived CI screening as important for allocating limited ED resources. Shorter, less specific testing, including the O3DY, was seen as feasible during triage, while longer, more specific screening, including the SBT, was seen as more feasible in roomed care areas. Both ED nurses and EDTs identified the need for electronic health record tools and dedicated screening teams to facilitate implementation.

Conclusion

ED nurses and EDTs support chronic CI screening if screening techniques and clinical teams can be optimized to make workflows feasible.