Improving Delirium Screening in Older Adults Presenting to the Emergency Assessment Unit (EAU), Horton Hospital
Abstract
Introduction
Delirium is a common, serious, and often under-recognised condition in older hospitalised adults. Early identification and management of reversible causes can reduce associated morbidity, mortality, length of stay, and long-term cognitive decline. The 4AT is a validated delirium screening tool recommended for acute hospital settings; however, completion rates in the Emergency Assessment Unit (EAU) were perceived to be low. This project aimed to improve delirium screening and detection in patients aged 65 years and over presenting to the EAU at Horton Hospital.
Method
All patients aged over 65 years presenting to the general medical on-call service via EAU during defined data collection periods. Electronic patient records were reviewed to determine whether a 4AT score had been completed during the initial clerking or admission process.
Results
Initially 38.2% of patients had a 4AT completed over a 2-week period, thereby confirming suboptimal delirium screening. Following the introduction of visual prompts, in the form of posters, a modest improvement to 41.6% of patients was recorded. The second intervention involved delivering delirium-specific teaching at weekly education sessions for clinicians on the acute take. Following this teaching, the 4AT was completed for 52.3% of patients, suggesting education had a meaningful impact on clinician behaviour.
Conclusions
Several barriers to completion of the 4AT were identified. These included both real- and perceived-time constraints during acute clerking and the misconception that the 4AT is time-consuming. There was also a poor understanding of delirium, its reversibility and its impact on outcomes. Our project demonstrated that passive interventions alone produce limited change, education improves uptake but is vulnerable to staff turnover. Sustainable improvement is likely to depend on workflow integration, system redesign, and shared team ownership, rather than reliance on awareness alone.
Comments
Delirium screening
This is a very engaging poster, I agree that integrating delirium assessment as part of the normal workflow e.g. including in a ward round proforma, may remove some of the human error of forgetting to check for delirium. I have also found in my own projects (similar to your findings) that educational interventions can also be very effective.
Excellent piece of work…
Excellent piece of work. Importance of delirium screening on admission remains underestimated. 4AT is usually overlooked due to staffing, time constraints and pressures of acute take but there is a need to understand that it is something we can assess and do while taking history and examination and takes less than 2 mins. This needs to be emphasized as much as possible.
4AT- in clerking
Excellent poster!
In my hospital we have the same issue . It is very rarely done during clerking the delirium assessment.
Gave you thought of electronic prompt on your computer system ?