Easy as 4-AT: Improving Delirium Screening in Acute Elderly Admissions with a Targeted Educational Intervention

Conor Cooper, Alexandra Hunter, Jeffrey Handyside, Derek Anthony Scott, Victoria Henderson

Research output: Contribution to conferencePosterpeer-review

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Background: Delirium is a common and serious complication of acute illness in elderly patients that frequently goes undiagnosed. The 4 A’s test (4-AT) is a simple and fast way of screening for delirium. A Healthcare Improvements Scotland inspection of Dr Gray’s hospital, Elgin in April 2017 revealed that the 4-AT was often being underused and incorrectly completed. 4-AT usage was audited and then a tailored educational intervention aimed at increasing and improving 4-AT usage was delivered.Methods: The medical and nursing notes of inpatients aged 65 and over on the Acute Care for the Elderly (ACE) ward were assessed for the presence of correctly completed 4-ATs on 15th January 2018. Junior clinicians were surveyed to identify reasons for non-completion before viewing a video demonstrating the quick and easy nature of the 4-AT and an infographic explaining 4-AT scoring. They were then surveyed on this educational intervention. The audit was repeated on 16th March 2018.Results: 4-AT completion rate increased from 57.7% to 60.9% between January and March (N.S. p>0.05). However, surveying of clinicians revealed that over 80% felt they were using the 4-AT on all elderly admissions. 55% said they had experienced difficulty completing a 4-AT. Junior doctors scored the video and the infographic 7/10 and 6.4/10 respectively but 67% disagreed that it made them more likely to carry out the 4-AT in all elderly admissions. Reminder stickers on patient notes and incorporation of the 4-AT into clerking forms were suggested as further interventions by respondents.Conclusion: 4-AT completion was not improved by the intervention indicating the need for a more wide-reaching, thorough intervention. The educational intervention seemed to be effective in demonstrating how to overcome issues with 4-AT completion but perhaps did not fully address the lack of awareness clinicians had about their own poor completion rates.
Original languageEnglish
Publication statusPublished - 1 Nov 2018
EventBritish Geriatric Society Autumn Meeting Scotland 2018 - Edinburgh, United Kingdom
Duration: 1 Nov 20181 Nov 2018


ConferenceBritish Geriatric Society Autumn Meeting Scotland 2018
Country/TerritoryUnited Kingdom
Internet address


  • 4AT
  • education
  • infographic
  • video
  • delirium
  • elderly
  • dr gray
  • NHS Grampian
  • physiology


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