Abstract
Delirium is a condition characterised by an acute, fluctuating change in mental status, with features such as inattention and disorganised thinking. It is potentially life-threatening with a high morbidity and mortality. While it can affect up to 30% of all older medical patients, it is often under-recognised due to the fluctuating nature of symptoms. The 4AT assessment tool allows for early and rapid recognition of Delirium. AIM To improve the detection of patients with delirium using the 4AT assessment tool. METHODOLOGY Patients admitted to hospital with delirium or acute confusion were identified by screening nursing hand-over lists from four wards, including two frailty wards. A retrospective analysis of their medical records was done, and specific data was extracted these including : their demographics, admission diagnoses, whether an Abbreviated Mental Test Score (AMTS) was performed on admission, and whether 4AT screening was done on the initial clerking, post-take ward round review or throughout the duration of the admission. RESULTS A total of twenty-three patients were identified across the four wards between July and November 2022. Of these, nine were male (39.1%) and fourteen were female (60.9%). The age range was 61–95 years (mean age 82). Twenty-one patients (91.3%) had an AMTS done and one patient (4.3%) had the 4AT done. Only one patient had both an AMTS and the 4AT done (4.3%). CONCLUSION From the data collected and interpreted, it can be concluded that the 4AT score is severely under-utilized which can ultimately lead to the delayed identification and management of patients with delirium. Several changes were implemented such as incorporation of 4AT stickers into clerking notes, and teaching sessions for junior doctors and nurses to raise awareness of Delirium and the 4AT tool. A second QIP cycle is currently in progress.