Checklists and guidelines can improve clinical practice, but often require time and effort to access, read and implement. To aid neuropsychology practice, we have developed ‘Smart Papers’ which provide clinical decision support in a user-friendly format: hints and tips in the margins of A4 ruled-paper. We have drawn up six sets of Smart Papers for specific areas in clinical neuropsychology.
– Clinical interview
– Distinguishing psychological from organic aetiologies
– Alzheimer’s and related dementias
– Movement disorders dementias
– Transient amnesia
These Smart Papers have been developed by Professor Narinder Kapur and Dr Veronica Bradley. They were originally developed for use by qualified and experienced neuropsychologists. In their current form, they are intended for use primarily by suitably qualified and experienced health care professionals who may be working collaboratively in multidisciplinary teams which include a neuropsychologist. They can also be used by students/trainees, but under close supervision of an experienced neuropsychologist or equivalent clinician.
The Smart Papers are meant to act as clinical guidelines, and not as definitive advice for specific courses of action. They are to be employed carefully, used in the context of other findings and other sources of advice, and also used in the context of relevant published literature at the time.
We do not accept responsibility for any adverse consequences resulting from their use.
In what situations would Smart Papers be useful?
Smart Paper formats could be useful in the following situations –
- Smart Papers can be of value as a training tool for junior staff and trainees, and also those who have just joined a Department and may not be familiar with the particular routines that are followed by that Department.
- Smart Papers can be valuable for senior staff who may find themselves rushed, under stress, tired, overloaded, etc. One of the cognitive premises on which the Smart Papers are based is that clinicians may make errors not because they lack relevant knowledge, but because for one reason or another they do not access that knowledge at the right time and in the right place for reasons such as those just outlined – their internal attentional systems may fail because they have been under too much pressure, or, in the case of senior staff, attentional control may simply be less efficient due to the aging process!
- As well as being used at the time of the consultation, which is its most common use, we find that Smart Papers may also be useful in two other ways – prior to seeing a patient if you know the clinical history and wish to check out guidelines as to what to ask in the interview, which tests to consider administering, etc; and after having seen a patient, if the Smart Paper was not used during the consultation, to help in deciding a diagnosis, tests to order, treatment to give, etc.
What are the advantages over just having a notepad together with a checklist?
- Since the checklist/guidance, etc is on the same paper that one actually writes on, one cannot forget or omit to have the checklist/guidance to hand.
- Having to find space for another A4 sheet of paper, and making reference to that, requires more time and more cognitive effort than just looking at one A4 sheet with key points at the edge.
How would Smart Papers be used?
Smart Papers can be used in several ways –
- As noted above, they can serve as a way of preparing for a clinical interaction with a patient if aspects of the clinical history are known, and the clinician wishes to remind himself/herself of the key questions to ask, key investigations to carry out, etc. Thus, the Smart Paper could form a mini-review that would obviate the need to consult a textbook or carry out an online search.
- More frequently, they will be used in the actual clinical interaction – instead of using ordinary lined paper, the clinician can avail him or herself of the Smart Paper where he/she can be reminded of items and investigations. The clinician is free to take notes initially without any reference to items in the boxes, but he/she can then check throughout the interview and at the end of the consultation if all relevant items have been covered.
One can envisage scenarios where an electronic version of a Smart Paper could be developed, and differing versions of a Smart Paper automatically brought up on screen, with electronic hand-written entry on the screen.