A Quality Improvement Project: Evaluation and Improvement of Collateral History Taking in Older Adults
Abstract
INTRODUCTION: Collateral history is a vital component of comprehensive geriatric assessment. Accurate and structured information from relatives or carers is essential for safe and effective clinical decision-making. This project aimed to evaluate how consistently collateral histories are obtained for older individuals and whether all essential components are documented.
METHOD: The first cycle was conducted in November–December 2024 and included 30 patients. A structured collateral history proforma was used to collect data under the headings: A – Ask what happened; B – Baseline; C – Carers, companions, concerns; D – Discussion of RESPECT form/LPA; and E – Escalation plan. The timing and frequency of documentation per patient were recorded. Findings were compared with the initial audit cycle conducted in 2020. Following analysis, targeted interventions were introduced. A repeat cycle was undertaken in May–June 2025 with 10 patients. A run chart was generated to assess trends following implementation of the interventions.
RESULTS: In 2024, 87% of patients had documentation of events leading to admission. Enquiry regarding baseline mobility improved from 10% (2020) to 70% (2024). However, documentation of LPA discussions and relatives’ concerns remained low at 27% and 37%, respectively. Discussion of the RESPECT form declined from 70% to 60%. Interventions included departmental teaching sessions, distribution of proforma, email circulation of educational posters, and addition of a cognitive baseline section following consultant feedback. In the 2025 cycle, improvements were observed across all domains. The run chart demonstrated documentation rates averaging 60% in 2020, 57% in 2024, and 100% in 2025. Findings were presented at the Clinical Audit Outcome Group meeting to support sustainability.
CONCLUSION: Despite its recognised importance, collateral history taking remains inconsistently structured in routine practice. This quality improvement project improved awareness, standardisation, and sustainability to enhance documentation for safer clinical decision-making, clearer escalation planning, and improved patient-centred care for older adults.
Comments
Data collection
I'm a bit confused as to when the proforma was re-introduced, was this before or after you collected data for 2024?
It sounds like the proforma was first introduced in 2020 but then fell out of use. Was there any comparison of the content of collateral histories taken with and without a proforma? If not, how do we know that the proforma itself is helpful, rather than just education and reminding people of what a good collateral should involve?