Graphical Instructions for Administration and Scoring the Mini-Cog: Results of a Randomized Clinical Trial

Objectives: To develop a novel set of graphical Mini-Cog instructions designed to aid clinicians previously untrained on the Mini-Cog in accurate administration and scoring and to determine whether use of these graphical instructions improved the speed and accuracy of deployment of this tool. Design: Randomized clinical trial. Setting: Testing was conducted in a simulated environment with a mock patient. Participants: Registered nurses working in inpatient or outpatient settings at a large academic medical center who had no prior exposure to or training with the Mini-Cog (N=92). Measurements: Our primary outcome was the composite proportion of nurses who made errors in administration or scoring of the Mini-Cog. Results: None of the nurses in the graphical instruction group and 28 (61%) in the standardized instructions group (15 (33%) made administration errors, 22 (48%) made scoring errors) made errors. Nurses randomly assigned to the graphical group were able to read (median 36 vs 54 seconds, P<.001), administer (46 vs 62 seconds, P<.001), and score (15 vs 84 seconds, P<.001) the Mini-Cog more quickly than those in the standardized instructions group. Conclusion: Graphical instructions increase the accuracy and speed of test administration in nurses without prior training in Mini-Cog administration. Further research is necessary to confirm these findings and evaluate the use of this method in other healthcare professionals and settings.