P-018A two-year review of the utility of dementia clinical pathway in a psychogeriatric inpatient unit in Singapore

There is a dearth of reports on the use of CP in dementia. Our dementia CP was developed in Nov 2004 by a multidisciplinary workgroup from the hospital's psychogeriatric department. To use CP as clinical tool to delivery more uniform and holistic services for inpatients with demetia. Patients admitted into the acute psychogeriatric wards in 2005–2006, who fulfilled ICD-9 criteria for dementia were enrolled. Those with concomitant schizophrenia, substance use disorder, unstable medical conditions and respite admissions were excluded. The CP consists of 3 seven-day phases: Admission, Stabilization and Discharge Phase. The roles of the multidisciplinary team-members, and the desired outcomes of each phase are delineated. The rating scales MMSE, NPI, and MBI were incorporated. The review was done by extracting data from the hospital's database and auditing the patients' medical records. The data was analyzed using SPSS version 13.0. 131 out of 222 patients with dementia were enrolled. The mean age was 79.2 (SD 8.7). There was almost equal number of male and female subjects (50.4% vs 49.6%). 108 (82.4%) were Chinese, 12 (9.2%) Malay, 8 (6.1%) Indian and 3 (2.3%) Others. There were no statistically significant differences in age, gender, and racial mix between the CP and non-CP groups. The average length of stay for the CP and non-CP group was 25.3 days (SD15.0) and 28.9 days (SD30.9) respectively (p=0.558). In the CP group, the mean number of co-morbid medical disorders was 3.6 (SD 2.0), mean MMSE was 11.9 (SD 5.8), mean NPI 21.9 (SD 15.4), and mean MBI 73.8 (SD 23.7). Audit of CP group showed a high level compliance by the multidisciplinary team in documentation of the assessment and treatment at various phases. CP can serve as a template to co-ordinate and document inpatient dementia care by the multidisciplinary team but it did not significantly reduce the length of hospitalization.