Background Delirium is a complication that presents a frequent challenge on our inpatient wards. Early recognition, detection and diagnosis of delirium can improve patient outcomes. The 4 ‘A’s Test (4AT) is a validated, rapid initial assessment tool that is a sensitive and specific method of screening for delirium in hospitalised patients.

Aims To determine the prevalence of use of the 4AT and to reveal if increasing staff awareness yielded improvement in use of the 4AT and detection of delirium.

Methods Initial data collection analysed inpatient notes on our rehabilitation (rehab) ward and medical assessment unit (MAU), for any terminology suggestive of an underlying delirium. Rehab ward nursing staff had already received training on delirium detection. Following this, formal teaching was delivered to junior doctors, and 4AT lanyard cards were distributed. One month later, another round of data collection was undertaken. Throughout the year, nurses in MAU were educated on delirium. Further data was collected 1 year later.

Results Baseline data analysis showed use of the 4AT on the rehab ward (75%) was significantly greater than MAU (20%). This was associated with increased detection/diagnosis of delirium on the rehab ward (75% diagnosed, 100% concordance with 4AT use) compared to MAU (20%). After 1 month, use of the 4AT improved dramatically on MAU (50%) and remained high on the rehab ward, improving to 87.5%. Results at 1 year show use of the 4AT continues to remain high on the rehab ward (75%) in at-risk patients. In addition, there remains a sustained improvement in 4AT use on MAU (40%) compared to baseline data (20%). Diagnosis and recording of delirium continues to improve on MAU (100% of suspected patients diagnosed), and remains high (75%) on our rehab ward.

Conclusion Our findings support the continued use of the 4AT screening tool and ongoing staff education and training in order to improve knowledge and confidence in detecting signs of delirium.