Most patients preparing for surgery expect to talk about anesthesia, pain control, and recovery plans. But few anticipate how surgery might impact their thinking—especially older adults who face real risk of post-operative delirium.
At UPMC’s Center for Perioperative Care (CPC), clinicians are taking proactive steps to screen for cognitive vulnerability before surgery. Thanks to a collaboration between UPMC Enterprises and BrainCheck, cognitive screening is now part of the pre-op routine—without slowing down workflow or requiring extra clinical staff.
The Challenge: Spotting Risk Before It’s Too Late
Post-operative delirium—sometimes referred to as “brain fog” after surgery—is common, especially in older adults. Patients may experience confusion, difficulty concentrating, memory lapses, or even longer-term changes in cognitive function. While some symptoms resolve quickly, others persist for weeks or months, impacting quality of life and recovery.
Historically, there has been no scalable way to identify patients at risk before surgery. Cognitive screening tools like the Montreal Cognitive Assessment (MoCA) can take 15+ minutes and require hands-on administration—a poor fit for fast-moving perioperative clinics.
The Solution: Scalable Digital Screening
In late 2021, UPMC Enterprises invested in BrainCheck, and partnered with the company to address the challenge. BrainCheck offers a digital cognitive test that patients can complete on an iPad in 10-15 minutes. Providers receive structured, objective results instantly, allowing them to assess cognitive baseline and flag potential vulnerabilities—all without disrupting clinic flow.
The Pilot: Screening 1,500+ Surgical Patients
In 2022, a pilot was launched at the CPC, facilitated by UPMC Enterprises and leveraging BrainCheck’s platform. The pilot in the CPC set out to answer a key question:
Can digital cognitive testing be embedded in the pre-op workflow to identify patients at risk for post-operative delirium—without burdening staff or delaying care?
The answer was yes. In the first phase of implementation, more than 1,500 patients’ cognition was assessed using BrainCheck at the CPC. The digital test was integrated into the Electronic Health Record (EHR), administered by staff using existing devices, and completed before patients met with their surgical team.
“We needed a tool to assess cognitive function in patients that would integrate seamlessly into our workflow, provide accurate information quickly, and be well received by patients,” said Stephen Esper, MD, Director of the CPC and a UPMC Anesthesiologist. “BrainCheck has helped us identify patients who might need closer monitoring after surgery—and gave us a way to do it at scale.”
Key Benefits for the Care Team
- Fast and efficient: Most patients completed the assessment in under 15 minutes, without additional provider time.
- Standardized results: Cognitive scores were returned in real time, helping providers tailor post-op recovery and discuss risks.
- Seamless integration: The test was embedded in existing pre-op workflows and coordinated with EHR documentation.
The experience also gave UPMC and BrainCheck teams the opportunity to fine-tune workflow integration, optimize usability, and prepare for broader clinical use.
Laying the Groundwork for Scale
The CPC pilot wasn’t just a test site—it became a blueprint for expanding BrainCheck into other UPMC practices, including family medicine and geriatrics.
By proving that cognitive assessments could be done efficiently in one of the most time-constrained clinical environments, UPMC demonstrated what’s possible with the right tool and the right partners.
“This wasn’t just a pilot,” said Chris Loughlin, CEO of BrainCheck. “It was a model of what’s possible when a forward-thinking health system meets a clinically validated digital tool. UPMC treated us like collaborators from day one—and together, we showed what real implementation looks like.”
What’s Next
As interest in perioperative cognitive care grows, UPMC’s approach stands out as a replicable model for other health systems. BrainCheck continues to support cognitive assessments at the CPC and is now helping primary care teams across UPMC integrate cognitive screenings into Annual Wellness Visits.
With tools like BrainCheck, health systems can finally make cognitive assessments a routine part of safe, patient-centered care.
Want to Learn More?
- Explore how BrainCheck is modernizing cognitive screening
- Learn how your health system can bring digital screening into perioperative care
Note: UPMC has a financial interest in BrainCheck.
