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Dementia screening: an audit of screening for reversible causes of dementia
- Kim Herbert, Elspeth Richardson, Adam Daly, Christine Carswell
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S81
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- Article
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- Open access
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Aims
This audit aimed to assess to what extent patients being referred for assessment of memory problems were receiving appropriate screening for reversible causes. We considered the blood tests recommended by the National Institute for Clinical Excellence (NICE).
BackgroundResearch into ‘reversible dementias’ identified numerous common underlying causes. As a result of this NICE complied comprehensive guidance on investigations which should be performed in the initial stages of assessing patients with memory problems, ideally at a primary care level. These investigations are also crucial at the point of secondary care assessment in order to make a confident diagnosis.
MethodDetails of patients referred by their GP to the Older Adult CMHT with memory problems over a one month period were collected. We then used the local laboratory database to note whether each of the eight recommended blood tests had been performed in the preceding 6 months. We measured this against an agreed standard of 95%.
After the first cycle of data collection we prepared business-card sized ‘aide memoirs’ for GPs that could serve as a quick reminder. These were sent out to all GPs in the area along with a letter outlining the audit findings.
ResultOverall 31 patients were included in the first cycle. 15 patients had all 8 dementia blood screens (48%), 13 (42%) had some of the recommended tests and 3 patients had no screening tests at all (10%). On average patients had 76.6% of the recommended bloods completed. The most commonly completed tests were Full Blood Count (FBC) and Urea & Electrolytes (U&Es), with blood Glucose being the most frequently omitted.
In cycle 2, 20 patients were included. Of these patients, 10 had the full complement of screening bloods (50%); 8 had some tests completed (40%) and 2 patients had no screening tests complete (10%). On average 76% of tests were completed. There was an improvement in the rate of completion of both Glucose and Liver Function Tests from cycle1.
ConclusionThis audit demonstrated that current practice does not meet the national standard in general. Our intervention produced a modest improvement in the proportion of patients who received a full complement of dementia screening tests, as well as increasing the rate of patients receiving a blood glucose as part of their screening. It would likely be beneficial to consider further intervention and a 3rd audit cycle in due course.
10 - The critical few: First among equals as parameters of strategic effectiveness
- from Part III - Performance measurement – frameworks and methodologies
- Edited by Andy Neely, Cranfield University, UK
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- Book:
- Business Performance Measurement
- Published online:
- 06 July 2010
- Print publication:
- 07 March 2002, pp 156-173
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Summary
The importance of defining the critical few
In today's complex and rapidly changing business environment, a strategic plan is an executive team's blueprint for changing the organization and growth. The process undertaken to develop that plan provides executives and other stakeholders with the opportunity to periodically re-think the business in a creative manner. In doing so, they can develop a shared understanding of what will be critical for future success, as well as enhance their knowledge of the business and its possible future environment. In our experience, if during this process executives are forced to make hard choices about what is critical, and focus future strategy around a limited (3–5) set of initiatives with associated specific, measurable objectives, the critical few, implementation effectiveness will be significantly improved, and organizational performance will be enhanced.
In this chapter, we provide the results of a research study which makes the case, previously only supported anecdotally, that building shared understanding among the executive team, of the critical few corporate initiatives, has a positive impact on strategic planning effectiveness, and hence on organizational performance. In describing our study more fully, this introductory section is followed by a discussion of the practical challenges in creating a shared understanding of the critical few. We then outline the process we have found useful for overcoming these challenges, enabling the definition of a highly focused strategic agenda – something we believe can be done for any organization, no matter how large or small. The chapter concludes with a discussion of our research approach, the research findings, and the implications of these findings for corporations and the executives who lead them.