Improving Early Recognition of Delirium Through 4AT Screening: A Single-Cycle Clinical Audit

Introduction

Delirium is a common and serious condition in older adults and is associated with increased morbidity, mortality, prolonged hospital stay, and institutionalisation. National guidance recommends routine delirium screening using validated tools such as the 4AT; however, delirium remains under-recognised in acute hospital settings. This project aimed to assess compliance with 4AT screening in older adults presenting with confusion and to implement interventions to improve delirium recognition.

Aim

To evaluate compliance with 4AT delirium assessments and documentation of delirium risk factors in eligible patients admitted to the General Medical Ward.

Method

A retrospective audit was conducted in a medical setting reviewing 50 consecutive patients aged ≥65 years presenting with confusion over a six-month period. Electronic admission documentation was reviewed to determine whether a 4AT assessment had been completed. Baseline findings informed a quality improvement initiative using Plan–Do–Study–Act methodology. Interventions included presentation of findings during departmental teaching sessions and staff education regarding delirium recognition and appropriate use of the 4AT tool. 

Results

Only 3 of 50 patients (6%) had a documented 4AT assessment on presentation, demonstrating poor compliance with recommended delirium screening practice and highlighting significant under-recognition of delirium in older adults presenting with confusion.

Conclusion(s)

This project identified substantial underutilisation of the 4AT tool despite national recommendations supporting routine delirium screening in older adults. Educational interventions have been introduced to improve staff awareness and screening practices, with repeat measurement ongoing to assess the effectiveness and sustainability of these interventions.