Abstract Body: Cognitive and speech impairments are common after stroke, contributing to greater functional dependence and a diminished quality of life. Despite this, during acute stroke hospitalization, screening for these impairments using validated tools is rarely conducted beyond routine bedside examinations by medical providers.
This quality improvement project aimed to enhance the early detection of speech and cognitive impairments in stroke patients. We hypothesized that there would be low concordance between provider perceptions of cognitive impairments and objective measures and that the referral rate for outpatient speech therapy would increase following the intervention.
From 07/01/24 to 08/31/24, stroke patients were screened for cognitive and language function using Saint Louis University Mental Status (SLUMS) and Quick Aphasia Battery (QAB), respectively. Providers were also surveyed on their perceptions of the patients' cognitive and language impairments and their intent to refer them for outpatient rehabilitation.
Analysis revealed a significant association between QAB score and providers’ beliefs, χ²(2, N = 19) = 6.97, p = 0.031, suggesting that providers are more likely to recognize impairments as severity increases. Linear regression comparing provider scores and SLUMS scores showed R² = 0.13, indicating that provider ratings were unreliable. A significant difference was found in referral rates before and after the intervention compared to the same period in 2023, χ²(1, N = 77) = 4.52, p = 0.034.
These findings indicate that mild and moderate cognitive impairments are frequently overlooked in acute stroke care. The discrepancy between provider assessments and standardized screening highlights the inadequacy of current bedside evaluations. Moreover, the significant increase in referrals following the implementation of validated screenings supports the effectiveness of this approach in promoting timely intervention for stroke survivors.