7 Preoperative practitioners in routine clinical practice can be trained to effectively and efficiently incorporate routine cognitive stratification into a high-volume, high-acuity, tertiary care preoperative clinic population. 6 However, clinical feasibility and utility of screening in routine clinical practice warrant further study. We have previously found that cognitive screening with the Mini-Cog © examination is easy to administer, and there are data showing that healthcare practitioners can administer the Mini-Cog with high reliability after minimal training and practice. We describe our preliminary experience with developing a training program and implementing routine cognitive screening, sustainable stratification, and documentation in our preoperative clinic. 3, 4 Preoperative cognitive dysfunction is a risk factor for postoperative delirium, which is independently associated with increased hospital length of stay and overall cost. The presence of impaired cognition before surgery is associated with higher 6-month and 1-year postoperative mortality rates and increased postdischarge institutionalization. 2 Without routine screening processes during preoperative assessment, undiagnosed cognitive impairment may be missed and therefore contribute to postoperative morbidity. The prevalence of cognitive impairment without dementia is significant and increases with age, reported in about 22.2% of patients above 71 years of age. 1 The screening tool used must be robust, reproducible, and feasible. A paradigm shift will be necessary to make this screening routine and not just used as a research tool. Preoperative testing programs and traditional systems of anesthesia evaluation do not routinely incorporate cognitive screening of the elderly patient into their preoperative assessments of vital organ systems. We outline a process showing our successful clinical implementation of sustainable cognitive stratification and documentation of routine cognitive screening. We describe our preliminary experience with developing a training program and implementing routine cognitive screening in a preoperative evaluation clinic. A paradigm shift will be necessary to make this screening routine and not just a research tool. Increasing recognition of the importance of preoperative cognitive assessment of the elderly surgical patient has resulted in a “call to action” from experts in this area. A&A Practice: Febru– Volume 12 – Issue 4 – p 125–127 Traditional systems of anesthesia evaluation do not routinely incorporate cognitive screening into preoperative assessments of vital organ systems.
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