Delirium screening in an acute geriatric ward by nurses using 4AT: results from a quality improvement project

Key summary pointsAimWe aimed to describe the prevalence and duration of delirium, and to evaluate the test accuracy of the delirium screening tool 4AT performed by nurses in an acute geriatric ward.FindingsThe prevalence of delirium in old, frail medical patients was 36%, two out of three patients recovered from their delirium within 4days after onset. The sensitivity of 4AT performed by nurses was lower than in previous studies where 4AT has been undertaken by experienced geriatricians or delirium researchers.MessageA thorough training of the staff might be required before the implementation of delirium screening with 4AT in a real-life clinical setting. AbstractMethodsWe conducted a retrospective chart-based analysis based on a quality improvement project in an acute geriatric ward. Delirium screening with the 4AT was performed by nurses within 24h after hospital admission. Delirium according to DSM-5 criteria was diagnosed retrospectively based on review of patient records.ResultsIn total, 59 patients (mean age 86years) were included. The prevalence of delirium was 36%. Two out of three patients recovered from their delirium within four days after onset. The sensitivity and specificity of the single-point assessment with 4AT performed by nurses were 50.0% [95% confidence interval (CI) 27.2-72.8] and 86.2% (95% CI 68.3-96.1).ConclusionPatients admitted to the acute geriatric ward had a high prevalence of delirium. The sensitivity of the 4AT performed by nurses for delirium was lower than in previous studies where it was undertaken by experienced geriatricians or delirium researchers.