(152) Quality Improvement Project at the Cleveland Clinic: Capacity Assessment Algorithm

Abstract: Quality Improvement Project at the Cleveland Clinic: Capacity Assessment Algorithm


Background

The assessment of capacity is a common consultation question that arises in the hospital setting, yet there is a limited understanding of what exactly capacity is or how to assess it among non-psychiatric healthcare providers. Understandably, each capacity question has its own level of complexity that can be influenced by several factors and fluctuate over time, making it more difficult to accurately determine. As such, this has led to some confusion and hesitancy from providers to carry out capacity assessments and thereby defaulting them to psychiatrists. While there are currently validated instruments to assess capacity, these can be time consuming and of limited clinical utility for providers who are already pressed for time in the inpatient setting.

We propose the Capacity Assessment Algorithm: an easy-to-follow flowsheet that directs the provider through each element of capacity and the next appropriate steps. This algorithm was created with the goal of providing education, increasing time efficiency, confidence and comfort for providers assessing capacity.


Methods

The provider requesting the capacity consult is asked to complete the Pre-Capacity Assessment Algorithm Questionnaire. The psychiatric consultant reviews the Capacity Assessment Algorithm with the provider prior to the patient assessment. The consultant and provider are present during the assessment to confirm/clarify relevant medical information. After the assessment, the provider completes the Post-Capacity Assessment Algorithm Questionnaire to assess their satisfaction with the algorithm.


Results

Data collection are in progress. Preliminary findings are encouraging with positive feedback from the post-assessment questionnaire and algorithm. Providers have expressed the usefulness of the algorithm in clarifying the components of the capacity assessment.


Discussion

Capacity assessments are one of the most commonly requested consults and can be difficult to navigate through. The primary provider is often in the best position to assess capacity as they have an understanding and longitudinal relationship with the patient. Based on our preliminary data, use of The Capacity Assessment Algorithm has been shown to be an effective approach for providing education on capacity assessments at the bedside.


Conclusion

Capacity can be assessed by any physician, yet it is often deferred to psychiatrists who are unfamiliar with the patient. Consultation-Liaison psychiatrists are in a unique position to educate healthcare providers and empower them to take the lead on routine capacity assessments, resulting in meaningful system wide changes that can ultimately provide improved and timely patient care.


References

Appelbaum, P. S. (2007). Assessment of Patients’ Competence to Consent to Treatment. New England Journal of Medicine, 357(18), 1834–1840.


Learning Objectives

1. To define the components of capacity.
2. To identify barriers providers face when assessing capacity.
3. To apply the Capacity Assessment Algorithm in the inpatient medical setting.