Time Matters: Evaluating the use of the Clock Drawing Test in Comprehensive Geriatric Assessments

Introduction 

Clock Drawing Tests (CDTs) are an integral part of Comprehensive Geriatric Assessments (CGAs). It is a brief, validated screening tool that assesses multiple cognitive domains. Studies have shown CDT performance is valuable in identifying early cognitive impairment, later functional decline and need for higher levels of care.  

Our quality improvement project (QIP) focused on evaluating the use of CDTs within CGAs completed by the Geriatric team at Royal Gwent Hospital (RGH). By identifying if CDTs are being used and the barriers to their application, we can implement strategies to increase its usage, contributing to early dementia identification. 

Methods

A retrospective analysis was conducted of patients reviewed by the department over a three-month period between January to March 2025. Data was collected on the percentage of CDTs completed during CGAs. Simultaneously, a staff survey was undertaken to identify barriers to performing CDTs. 

Results

A total of 118 patients were identified, of whom 39.0% (n=46) were excluded due to absence of a CGA or known background of dementia. Of the 72 patients analysed, 65.3% were female (n = 47) and 34.7% were male (n = 25). 13.9% had a 4AT score of 4 and above (n = 10). CDT completion was low at 1.4% (n=1). Departmental feedback suggests a lack of understanding on how to perform the test and interpret results.   

Conclusion 

We have highlighted the underutilisation of CDTs despite its benefits. As a result, we delivered targeted departmental teaching on the utilisation and interpretation of CDTs. We have also created posters on CDTs with a scoring guide that will be displayed on geriatric wards to encourage and support colleagues in using the test for the first cycle of our QIP. Following implementation, we plan to re-audit CDT utilisation within the department, aiming for 100% uptake of the CDT.