ArticleCureus2025
Implementing Standardised Delirium Screening Using the Four A's Test (4AT) in the Emergency Department: A Quality Improvement Project.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Review
- Delirium Screening in the Emergency Department: Barriers, Enablers and Alignment With Clinical Standards-A Mixed-Methods Study.Emergency medicine Australasia : EMA · 2026Article
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionElderly patients are at risk of developing an acute, temporary change in cognition referred to as delirium. Those identified as at risk should be screened promptly when presenting to the emergency department to ensure early recognition and reversal of the underlying cause to improve outcomes. Our quality improvement project (QIP) aims to introduce standardised delirium screening into the emergency department with a target of 80% adherence. MATERIALS AND
methodsWe conducted a QIP at Southend University Hospital emergency department in England from June 15, 2023 until November 7, 2023. We planned to implement the four A's test (4AT) as the recognised standardised scoring system for delirium screening in those 65 years of age or older. The interventions included a preparatory survey, formal teaching and poster prompts. We performed three cycles of data collection with 50 patients in each set of data. Our target was 80% use of the 4AT.
resultsThis QIP demonstrates a modest improvement in the use of a 4AT as the standardised delirium screening in those 65 years of age or older; however, work is still required. The first cycle of 50 patients revealed that 0 (0%) patients had documented use of 4AT for screening. Our second cycle of 50 patients performed after formal teaching to emergency doctors revealed that six (12%) patients had a documented 4AT. The third cycle performed after poster prompts had four (8%) patients having documented 4AT screening. Whilst there is improvement from baseline levels, the initial uptake in the use of 4AT was not sustained.
conclusionAn improvement in 4AT usage was demonstrated compared to baseline with the most effective intervention being formal teaching; however, the target of 80% was not met. There are notable barriers to the implementation including rotational training and challenging working conditions. This highlights the need for robust quality improvement and systemic level change with consideration given to to implementation of 4AT during nurse triage, perhaps utilising formal teaching.
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