Abstract
Introduction
Delirium is an acute or subacute neuropsychiatric syndrome characterized by disturbed consciousness, attention, and cognition. It is common among hospitalized older adults and is often underdiagnosed, which can negatively affect patient outcomes. The 4AT tool is a rapid screening instrument for delirium, particularly suited for ward-based assessments. This Quality Improvement Project (QIP) aimed to evaluate the use of the 4AT score in diagnosing delirium in inpatients and to raise awareness among healthcare providers to improve its usage.
Method
A retrospective analysis was conducted over two cycles in three wards at Orpington Hospital. In the first cycle (14/04/2025–20/04/2025), notes from 60 inpatients were reviewed via the EPIC system to identify those diagnosed with delirium and whether a 4AT score was documented. Findings were presented at hospital educational meetings and geriatric journal clubs to educate staff. A second cycle was performed (23/06/2025–29/06/2025) using the same methodology on 56 patients to assess the impact of the intervention.
Results
In the first cycle, 28 of 60 patients (46.67%) were diagnosed with delirium, but only 8 (28.57%) had a 4AT score documented. In the second cycle, 25 of 56 patients (44.64%) had a diagnosis of delirium, with 11 (44%) having a 4AT score recorded. This demonstrates an improvement in the use of the 4AT tool following the educational interventions.
Conclusion
The QIP demonstrated that targeted education and awareness-raising among clinical staff led to improved use of the 4AT assessment tool for delirium. Continued efforts to integrate 4AT use into routine practice can enhance early recognition and management of delirium, ultimately improving patient outcomes.