4AT Screening on a Care of the Elderly Ward: a Quality Improvement Project on Delirium

Introduction
Delirium affects up to 50% of hospitalised older adults (≥65 years) and is significantly associated with patient morbidity and healthcare burden. The 4AT is a rapid, practical, and cost-effective screening tool for delirium. This project evaluated the effectiveness of 4AT implementation on a care of the elderly ward and assessed strategies to increase its use.

Methods
All new admissions to a care of the elderly ward over a one-month period were reviewed. Data collected included: suspected delirium, known/suspected cognitive impairment, and completion of initial 4AT screening prior to ward transfer. On the ward, documentation of initial delirium/dementia assessment by nursing staff, 4AT screening by doctors, and frequency of follow-up 4ATs were recorded. Interventions to promote 4AT use included aide-mémoire tools and dedicated teaching sessions for nursing staff and healthcare assistants. Data were re-collected post-intervention. In addition, self-evaluation surveys were administered to doctors to assess confidence in recognising delirium pre- and post-intervention.

Results
Following the interventions, completion of initial delirium/dementia assessments by nursing staff on the ward increased from 72% (n=54) to 90% (n=50), initial 4AT screening on the ward improved from 3.7% to 30%, and follow-up 4AT use increased from 1.9% to 26%. Doctors also reported higher confidence in recognising delirium.

Conclusions
Targeted education and simple ward-based prompts significantly increased the use of 4AT and improved staff confidence in delirium recognition. Embedding structured delirium screening into routine practice may enhance early detection and management of this common and serious condition.