Improving Delirium Screening in Older Adults Presenting to the Emergency Assessment Unit (EAU), Horton Hospital

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.