ArticleEuropean geriatric medicine2022
Barriers to completing the 4AT for delirium and its clinical implementation in two hospitals: a mixed-methods study.
Article in European geriatric medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Awake craniotomy and language assessment in deaf patients: a systematic review of feasibility, communication strategies, and outcomes.Journal of neuro-oncology · 2026Pooled it
- Risk factors and risk stratification approaches for delirium screening: A Geriatric Emergency Department Guidelines 2.0 systematic review.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2024Pooled it
- Nurses' usage of validated tools to assess for delirium in general acute care settings: A scoping review.International journal of nursing studies advances · 2026Review
- "Pleasantly confused" and missed opportunities for delirium recognition: A hospital record audit.International journal of nursing studies advances · 2026Article
- Understanding the impact of Multiple Long-Term Conditions (MLTC) on the completion of delirium screening documentation: analysis using routinely collected clinical data.European geriatric medicine · 2026Article
- Nurses' Compliance with Delirium Assessment Protocol in a Tertiary Hospital: A Retrospective Study.Healthcare (Basel, Switzerland) · 2026Article
- Point-of-Care EEG for Non-Convulsive Seizure and Status Epilepticus: Advances, Limitations, and Future Directions.Journal of clinical medicine · 2026Review
- Effectiveness of Music Therapy for Delirium in Acute Hospital Settings: A Scoping Review.Nursing reports (Pavia, Italy) · 2026Review
- Delirium and cognitive assessment in national hip fracture registries: a scoping review.European geriatric medicine · 2025Article
- Delirium prevalence, diagnostic uncertainty and outcomes in ORCHARD-EPR: validation against prospective reference cohorts.Age and ageing · 2025Article
- Pilot implementation of an electronic diagnostic support tool (AiD-DST) designed to identify the cause(s) of delirium.Australasian journal on ageing · 2025Article
- Improving delirium assessments in acute senior health: A quality improvement project for care of the older person.BMC geriatrics · 2024Observational
- Real-World Adherence to a Delirium Screening Test Administered by Nurses and Medical Staff during Routine Patient Care.Brain sciences · 2024Article
- The 4AT, a rapid delirium detection tool for use in hospice inpatient units: Findings from a validation study.Palliative medicine · 2024Article
- Identification and information management of cognitive impairment of patients in acute care hospitals: An integrative review.International journal of nursing sciences · 2024Review
- Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions.Age and ageing · 2022Article
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2 authors.
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Abstract
purposeTo assess the clinical implementation and barriers to completing the 4AT for delirium in general medical and geriatric patients over 75 years upon admission to Wellington and Kenepuru Hospitals during the first eight months of 2017, 2018 and 2019.
methodsRetrospective data from electronic health records were analysed using an explanatory-sequential mixed-methods approach. The initial quantitative phase measured doctors' adherence to the 4AT and the rate of positive 4ATs (≥ 4). The subsequent qualitative phase identified doctors' main reasons for omitting the 4AT through conventional content analysis.
resultsThe quantitative population included 7799 acute admissions (mean age 84, 58.2% female). There was good clinical implementation of the 4AT, evidenced by an overall adherence rate of 83.2% and a rate of positive 4ATs of 14.8% that is in keeping with expected delirium rates in similar settings. The qualitative sample consisted of 875 acute admissions (mean age 84, 56.3% female) with documented reasons for omitting the 4AT. The main barriers to completing the 4AT were: reduced patient alertness, communication barriers (language, deafness, aphasia and dysarthria), prioritising patients' wellness and comfort (addressing critical illnesses, symptoms, end-of-life issues and promoting sleep), pre-existing cognitive disorders, and unstructured delirium assessments.
conclusionAdherence to the 4AT was high and sustainable in both hospitals. Most barriers to completing the 4AT were potentially avoidable. Education about the 4AT in relation to these barriers may improve its implementation.
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