Presentation
PS14 - Toward Cognitive Safety in Healthcare: A New Strategy for Continuous Assessment and Total Cognitive Quality Management
SessionPoster Session 1
DescriptionHFES HC 2025 Submission
Topic Overview
This presentation focuses on the development of a Total Cognitive Quality Management (TCQM) system in healthcare to address the issue of unobserved and uncontrolled cognitive decline resulting from medical interventions. While healthcare traditionally prioritizes physical outcomes, interventions such as chemotherapy, sedatives, tranquilizers, and anesthetics carry cognitive risks that are often overlooked. This presentation argues that cognitive safety must become an explicit goal, with healthcare systems implementing continuous, easy-to-administer assessments of cognitive functioning before, during, and after clinical encounters. By systematically tracking cognitive changes in the context of medical interventions, healthcare providers can balance trade-offs between physical health treatments and cognitive impacts, ensuring that both brain and body are treated with equal care.
Application and Need
Cognitive safety is a critical yet under-addressed component of patient care. Many medical treatments that focus on saving or improving physical health carry cognitive risks. For instance, chemotherapy has well-documented cognitive side effects (“chemo brain”), and sedatives or anesthetics can impair cognitive function, particularly in older adults, leading to conditions such as POCD (post-operative cognitive disorder). Current healthcare systems lack mechanisms to routinely assess and track these cognitive risks, leading to delayed or missed opportunities for mitigation. This presentation proposes a Total Cognitive Quality Management strategy to integrate cognitive assessment (and ultimately cognitive safety related interventions) directly into healthcare workflows.
The TCQM framework envisions frequent, sensitive measures of cognitive functioning—particularly executive functioning and working memory—before, during, and after treatments. This data can be used to track cognitive changes in real-time and identify early signs of decline. Linking cognitive outcomes to a TCQM system ensures that brain health is given the same attention as physical health, enabling clinicians to make more informed decisions about interventions with cognitive risks.
Background and Challenges
Healthcare systems emphasize physical conditions and tend to ignore cognitive impacts of treatments. For instance, chemotherapy, while critical for treating cancer, may lead to long-lasting cognitive side effects.
Currently, cognitive assessments are typically limited to certain points in care—often when patients or families report noticeable cognitive decline. The paper and pencil tests typically used (such as the MMSE, MoCA and CAM) are relatively insensitive and target simple distinctions such as whether or not a patient has dementia, dementia, or mild cognitive impairment. This approach is reactive, addressing problems only after they become severe. Moreover, cognitive assessments are often burdensome or impractical for routine use. Healthcare providers need simple, easily administered tools to track cognitive changes without disrupting workflows. Over the past 10 years we have developed a suite of cognitive assessment games (BrainTagger, [1]) that provide sensitive assessments of working memory and executive functions. The response inhibition game from BrainTagger has been used successfully to screen for delirium in emergency departments [2]. BrainTagger games have also been validated against standard psychology tasks ([3], [4]). All of the BrainTagger games have also been shown to be measures of fluid intelligence with age-related changes in BrainTagger game performance reflecting age-related changes in fluid intelligence ([5]), following a pattern where performance improves during brain development (up to the early 20s), flattens during brain maturation (up to the early 50s) and then declines as the aging brain is increasingly impacted by neurodegeneration and loss of white matter integrity.
Another challenge lies in weighing tradeoffs. Some treatments may improve physical health at the expense of cognitive function, and data-driven strategies are needed to manage risks effectively.
Proposed Solution: Total Cognitive Quality Management System
We propose a Total Cognitive Quality Management (TCQM) system to ensure cognitive safety in healthcare. The TCQM system will be built on three core pillars:
1. Continuous Cognitive Assessment: Routine, frequent measurements of cognitive function (working memory and executive functions) will be implemented throughout the patient’s care journey. These measures should be easy to administer in the form of brief cognitive tests integrated into regular patient check-ins or digital health tools.
2. Tracking and Monitoring Cognitive Outcomes: All cognitive data will feed into the TCQM system, which will track cognitive changes over time. This allows healthcare providers to identify trends, detect early signs of decline, and adjust care plans accordingly. For example, if a patient undergoing chemotherapy shows signs of cognitive impairment, the care team can intervene early, possibly changing the type or dosage of chemotherapy.
3. Balancing Tradeoffs Between Physical and Cognitive Health: The TCQM system will provide decision support tools to help clinicians navigate the complex tradeoffs between physical and cognitive health. For example, a treatment plan involving anesthesia for surgery might be reassessed if the patient has cognitive impairment and is at high risk of further cognitive decline due to the impact of certain types of anesthetic. Trade-offs that occur between physical and cognitive health issues should be addressed explicitly and transparently, with a focus on patient-centered care.
The TCQM system will foster a more holistic approach to healthcare, ensuring that brain health is not sacrificed in pursuit of physical recovery. It promotes a shift from reactive to proactive care, where cognitive decline is prevented or mitigated through early detection and timely interventions, rather than being treated as some kind of age-related disease that is left to run its course.
Importance of the Message and Key Takeaways
The central message of this presentation is that cognitive safety must become a standard part of healthcare practice. Implementing a TCQM system ensures that healthcare providers can monitor and mitigate cognitive risks in real-time, leading to better patient outcomes.
The key takeaways from the presentation include:
• Cognitive risks are a hidden threat in healthcare: Many medical interventions can negatively affect brain health, and these impacts often go unnoticed without systematic assessment.
• Routine cognitive assessment is essential: Brief, frequent cognitive measurements integrated into clinical workflows will enable early detection of cognitive decline.
• TCQM enables better decision-making: By tracking cognitive outcomes and managing tradeoffs between physical and cognitive health, the TCQM system ensures patient-centered care.
• Proactive care is better care: Shifting from reactive to proactive cognitive assessment will improve patient outcomes and enhance the quality of life for individuals receiving healthcare services.
Overview of the Presentation
The presentation will be structured into several key sections:
1. Introduction to Cognitive Safety and Healthcare Risks
Overview of cognitive risks associated with medical interventions.
Examples of cognitive impacts from treatments like chemotherapy, anesthesia, and sedatives.
2. Improving the State of the Art in Clinical Cognitive Assessment
Review of current cognitive assessments in clinical settings.
Benefits of using cognitive assessment games for clinical assessment.
3. Introducing Total Cognitive Quality Management (TCQM)
Overview of the TCQM framework and its core components: continuous assessment, tracking, and balancing trade-offs.
Examples of how TCQM would function in practice.
4. Benefits of Implementing TCQM in Healthcare
Improved patient outcomes through early detection of cognitive decline.
Enhanced decision-making tools for clinicians to implement cognitive safety.
5. Conclusion and Future Directions
Emphasizing the need for clinical trials of advanced cognitive assessment tools.
Calling for the integration of TCQM into healthcare systems.
References
1. https://doi.org/10.1177/2169506723119
2. https://doi.org/10.1111/jgs.16095
3. https://doi.org/10.1080/23279095.2019.1683561
4. https://doi.org/10.1080/23279095.2023.2183361
5. Getting Patients Out of Harm’s Way: Preventing Unnecessary Impairment with Cognitive Assessment Games. Manuscript under revision.
Topic Overview
This presentation focuses on the development of a Total Cognitive Quality Management (TCQM) system in healthcare to address the issue of unobserved and uncontrolled cognitive decline resulting from medical interventions. While healthcare traditionally prioritizes physical outcomes, interventions such as chemotherapy, sedatives, tranquilizers, and anesthetics carry cognitive risks that are often overlooked. This presentation argues that cognitive safety must become an explicit goal, with healthcare systems implementing continuous, easy-to-administer assessments of cognitive functioning before, during, and after clinical encounters. By systematically tracking cognitive changes in the context of medical interventions, healthcare providers can balance trade-offs between physical health treatments and cognitive impacts, ensuring that both brain and body are treated with equal care.
Application and Need
Cognitive safety is a critical yet under-addressed component of patient care. Many medical treatments that focus on saving or improving physical health carry cognitive risks. For instance, chemotherapy has well-documented cognitive side effects (“chemo brain”), and sedatives or anesthetics can impair cognitive function, particularly in older adults, leading to conditions such as POCD (post-operative cognitive disorder). Current healthcare systems lack mechanisms to routinely assess and track these cognitive risks, leading to delayed or missed opportunities for mitigation. This presentation proposes a Total Cognitive Quality Management strategy to integrate cognitive assessment (and ultimately cognitive safety related interventions) directly into healthcare workflows.
The TCQM framework envisions frequent, sensitive measures of cognitive functioning—particularly executive functioning and working memory—before, during, and after treatments. This data can be used to track cognitive changes in real-time and identify early signs of decline. Linking cognitive outcomes to a TCQM system ensures that brain health is given the same attention as physical health, enabling clinicians to make more informed decisions about interventions with cognitive risks.
Background and Challenges
Healthcare systems emphasize physical conditions and tend to ignore cognitive impacts of treatments. For instance, chemotherapy, while critical for treating cancer, may lead to long-lasting cognitive side effects.
Currently, cognitive assessments are typically limited to certain points in care—often when patients or families report noticeable cognitive decline. The paper and pencil tests typically used (such as the MMSE, MoCA and CAM) are relatively insensitive and target simple distinctions such as whether or not a patient has dementia, dementia, or mild cognitive impairment. This approach is reactive, addressing problems only after they become severe. Moreover, cognitive assessments are often burdensome or impractical for routine use. Healthcare providers need simple, easily administered tools to track cognitive changes without disrupting workflows. Over the past 10 years we have developed a suite of cognitive assessment games (BrainTagger, [1]) that provide sensitive assessments of working memory and executive functions. The response inhibition game from BrainTagger has been used successfully to screen for delirium in emergency departments [2]. BrainTagger games have also been validated against standard psychology tasks ([3], [4]). All of the BrainTagger games have also been shown to be measures of fluid intelligence with age-related changes in BrainTagger game performance reflecting age-related changes in fluid intelligence ([5]), following a pattern where performance improves during brain development (up to the early 20s), flattens during brain maturation (up to the early 50s) and then declines as the aging brain is increasingly impacted by neurodegeneration and loss of white matter integrity.
Another challenge lies in weighing tradeoffs. Some treatments may improve physical health at the expense of cognitive function, and data-driven strategies are needed to manage risks effectively.
Proposed Solution: Total Cognitive Quality Management System
We propose a Total Cognitive Quality Management (TCQM) system to ensure cognitive safety in healthcare. The TCQM system will be built on three core pillars:
1. Continuous Cognitive Assessment: Routine, frequent measurements of cognitive function (working memory and executive functions) will be implemented throughout the patient’s care journey. These measures should be easy to administer in the form of brief cognitive tests integrated into regular patient check-ins or digital health tools.
2. Tracking and Monitoring Cognitive Outcomes: All cognitive data will feed into the TCQM system, which will track cognitive changes over time. This allows healthcare providers to identify trends, detect early signs of decline, and adjust care plans accordingly. For example, if a patient undergoing chemotherapy shows signs of cognitive impairment, the care team can intervene early, possibly changing the type or dosage of chemotherapy.
3. Balancing Tradeoffs Between Physical and Cognitive Health: The TCQM system will provide decision support tools to help clinicians navigate the complex tradeoffs between physical and cognitive health. For example, a treatment plan involving anesthesia for surgery might be reassessed if the patient has cognitive impairment and is at high risk of further cognitive decline due to the impact of certain types of anesthetic. Trade-offs that occur between physical and cognitive health issues should be addressed explicitly and transparently, with a focus on patient-centered care.
The TCQM system will foster a more holistic approach to healthcare, ensuring that brain health is not sacrificed in pursuit of physical recovery. It promotes a shift from reactive to proactive care, where cognitive decline is prevented or mitigated through early detection and timely interventions, rather than being treated as some kind of age-related disease that is left to run its course.
Importance of the Message and Key Takeaways
The central message of this presentation is that cognitive safety must become a standard part of healthcare practice. Implementing a TCQM system ensures that healthcare providers can monitor and mitigate cognitive risks in real-time, leading to better patient outcomes.
The key takeaways from the presentation include:
• Cognitive risks are a hidden threat in healthcare: Many medical interventions can negatively affect brain health, and these impacts often go unnoticed without systematic assessment.
• Routine cognitive assessment is essential: Brief, frequent cognitive measurements integrated into clinical workflows will enable early detection of cognitive decline.
• TCQM enables better decision-making: By tracking cognitive outcomes and managing tradeoffs between physical and cognitive health, the TCQM system ensures patient-centered care.
• Proactive care is better care: Shifting from reactive to proactive cognitive assessment will improve patient outcomes and enhance the quality of life for individuals receiving healthcare services.
Overview of the Presentation
The presentation will be structured into several key sections:
1. Introduction to Cognitive Safety and Healthcare Risks
Overview of cognitive risks associated with medical interventions.
Examples of cognitive impacts from treatments like chemotherapy, anesthesia, and sedatives.
2. Improving the State of the Art in Clinical Cognitive Assessment
Review of current cognitive assessments in clinical settings.
Benefits of using cognitive assessment games for clinical assessment.
3. Introducing Total Cognitive Quality Management (TCQM)
Overview of the TCQM framework and its core components: continuous assessment, tracking, and balancing trade-offs.
Examples of how TCQM would function in practice.
4. Benefits of Implementing TCQM in Healthcare
Improved patient outcomes through early detection of cognitive decline.
Enhanced decision-making tools for clinicians to implement cognitive safety.
5. Conclusion and Future Directions
Emphasizing the need for clinical trials of advanced cognitive assessment tools.
Calling for the integration of TCQM into healthcare systems.
References
1. https://doi.org/10.1177/2169506723119
2. https://doi.org/10.1111/jgs.16095
3. https://doi.org/10.1080/23279095.2019.1683561
4. https://doi.org/10.1080/23279095.2023.2183361
5. Getting Patients Out of Harm’s Way: Preventing Unnecessary Impairment with Cognitive Assessment Games. Manuscript under revision.
Event Type
Poster Presentation
TimeMonday, March 314:45pm - 6:15pm EDT
LocationFrontenac Foyer
Digital Health (DH)
Simulation and Education (SE)
Hospital Environments (HE)
Medical and Drug Delivery Devices (MDD)
Patient Safety and Research Initiatives (PS)