More work is needed on structured admission proformas
We read the recent article by Smallwood et al with interest.1 We agree that clerking pro formas can increase the completeness of initial information gathering, but we are concerned that they do not always reflect the needs of the elderly population who form the majority of unplanned medical admissions.2
We recently contacted all English trusts delivering acute general medicine to survey their clerking documents for features particularly pertinent to older people. We received replies from 53 trusts using a pro forma. Table 1 shows the results.
Encouragingly, most documents included a cognitive assessment, perhaps driven by the recent dementia Commissioning for Quality and Innovation (CQUIN) national goals. However, we found it astonishing that despite its widespread availability, four documents reproduced the 10 question abbreviated mental test (AMT) incorrectly, with one document containing three inaccuracies. Only 38% of documents included a tool for assessing for delirium, despite delirium being present on admission in up to 29% of older patients.3
No single pro forma can be universally suitable, as they should reflect local service models and availability of facilities. However, there is room for improvement in many of the documents currently in use.
- © Royal College of Physicians 2018. All rights reserved.
References
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- Smallwood N
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- Cornwell J
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