Delirium is a common syndrome of acute brain dysfunction, the pathophysiology of which remains uncertain. It is a clinical diagnosis based on a detailed history, examination, and relevant investigations. Elderly patients with pre-existing conditions, such as cognitive impairment or severe acute illness, are at increased risk of delirium. The 4 A’s Test (4AT) is a widely used screening tool for delirium and may also help predict mortality (Evensen et al., 2021). Recent findings from the National Audit of Inpatient Falls (NAIF) highlighted six key domains contributing to inpatient falls. All United Kingdom (UK) trusts and health boards are encouraged to review their data and implement local improvements. The audit recommends a delirium screening target of 65% or higher to enhance patient care and safety, thereby reducing inpatient falls. We conducted a baseline audit of all acute admissions from the emergency department to the care of the elderly wards in September 2025 in our local hospital. Documentation of the Single Question in Delirium (SQiD) and 4AT was reviewed at the point of medical clerking and during ward care. Fewer than 10% of patients had documented 4AT assessments, which is significantly below the NAIF target. This finding prompted the initiation of a quality improvement project aimed at increasing delirium screening among clinicians and, consequently, reducing the incidence of inpatient falls. Secondary outcomes for the project include length of hospital stay and all-cause mortality.

Authors:
Chi Kang Gan, Basildon University Hospital, United Kingdom
Olga Ciobanu, Basildon University Hospital, United Kingdom
Prativa Rai, Basildon University Hospital, United Kingdom
Meera Mangan, Basildon University Hospital, United Kingdom
Soma Kar, Basildon University Hospital, United Kingdom

About the Presenter(s)
Dr Chi Kang Gan is a current medical doctor at Basildon Hospital, United Kingdom. He is interested in intensive care medicine, especially trauma and palliative care in the ICU.

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