Delirium Awareness: Bridging the Gap Between Screening and Clinical Practice

Delirium is an acute onset of fluctuating consciousness associated with impaired cognition and perception, commonly encountered in elderly patients. Prompt recognition allows early treatment of reversible causes. 4AT is a screening tool for rapid assessment of delirium.

By assessing the use of the 4AT score in Orthogeriatric patients, this quality improvement project aimed to improve assessment and management of delirium with both verbal and written interventions.

Weekly data was collected from Orthogeriatric inpatients across three PDSA cycles including the admission 4AT score, reviewing notes for mention of delirium, acute confusion and cognitive decline and whether the causes were considered and managed.

Cycle one demonstrated that 98% of patients had a 4AT assessment on admission. 38% had a score suggestive of delirium or cognitive impairment. 5.7% of patients had delirium considered at clinical review. 2% had a cause of delirium documented.

Daily board-round announcements to the clinical team highlighted delirium, prompt review of 4AT and screening for causes using the ‘PINCHME’ model.

After cycle 2, 100% of patients had 4AT completed on admission, 55% had evidence that delirium, acute confusion or cognitive decline was considered at review and 50% had a cause for delirium documented.

This project demonstrated an improved awareness of delirium and its causes amongst clinicians through written and verbal interventions. The next steps for sustainable change are to propose the introduction of an automatic online delirium alert in patients scoring ≥4 on 4AT and designing a digital confusion screen proforma to ensure thorough assessment of these patients.