Testing a novel Clinical Assessment Tool to identify Hospital-Acquired Deconditioning

Introduction: Previous work identified eleven domains related to Hospital-Acquired Deconditioning (HAD), and a clinical assessment tool (CAT) was subsequently developed to measure changes in patient condition during a hospital stay. As the CAT aimed to identify and monitor HAD in hospital in-patients, testing was required to ensure the tool was appropriate for use. This project was funded by NHS Wales Six Goals Programme/Value Transformation and led by CEDAR.

Methods: Two rounds of pilot testing were undertaken, involving staff members in two health boards. Iterative development continued after each round of testing following feedback sought from the staff members involved, by capturing completed tool outputs from assessments, and understanding a service user perspective.

Results: Over 500 assessment reports were received, for 105 individual patients: 66 were found to have deconditioned in at least one domain while in hospital, and 79 experienced improvements in their condition. Eleven members of staff provided feedback in the first pilot and eight in the second pilot, which aided in amending and finalising the CAT. A service user additionally provided positive feedback on the tool. The CAT was thought to accurately identify patient condition, including early indicators of HAD. Staff involved in testing were generally supportive of using the CAT in practice. However, they noted that to maximise benefits, a wider electronic rollout across hospital sites is required.

Conclusions: Embedding the new tool into practice could lead to earlier identification of HAD and, when combined with training for staff in preventing deconditioning, subsequent improvements in patient outcomes. Additionally, strategies are required to apply targeted interventions as early as possible in care for patients who are found to be deconditioning. This work will be implemented nationwide as the CAT is being rolled out across Wales to enhance the detection of HAD in hospital patients. Further work is planned to validate the tool.