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 conferencePoster

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Abstract

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
https://www.bgs.org.uk/events/scotland-autumn-meeting-2018

Conference

ConferenceBritish Geriatric Society Autumn Meeting Scotland 2018
CountryUnited Kingdom
CityEdinburgh
Period1/11/181/11/18
Internet address

Fingerprint

Delirium
Scotland
Inpatients
Nursing
Delivery of Health Care

Keywords

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

Cite this

Cooper, C., Hunter, A., Handyside, J., Scott, D. A., & Henderson, V. (2018). Easy as 4-AT: Improving Delirium Screening in Acute Elderly Admissions with a Targeted Educational Intervention. Poster session presented at British Geriatric Society Autumn Meeting Scotland 2018, Edinburgh, United Kingdom.

Easy as 4-AT: Improving Delirium Screening in Acute Elderly Admissions with a Targeted Educational Intervention. / Cooper, Conor; Hunter, Alexandra; Handyside, Jeffrey; Scott, Derek Anthony; Henderson, Victoria.

2018. Poster session presented at British Geriatric Society Autumn Meeting Scotland 2018, Edinburgh, United Kingdom.

Research output: Contribution to conferencePoster

Cooper, C, Hunter, A, Handyside, J, Scott, DA & Henderson, V 2018, 'Easy as 4-AT: Improving Delirium Screening in Acute Elderly Admissions with a Targeted Educational Intervention' British Geriatric Society Autumn Meeting Scotland 2018, Edinburgh, United Kingdom, 1/11/18 - 1/11/18, .
Cooper C, Hunter A, Handyside J, Scott DA, Henderson V. Easy as 4-AT: Improving Delirium Screening in Acute Elderly Admissions with a Targeted Educational Intervention. 2018. Poster session presented at British Geriatric Society Autumn Meeting Scotland 2018, Edinburgh, United Kingdom.
Cooper, Conor ; Hunter, Alexandra ; Handyside, Jeffrey ; Scott, Derek Anthony ; Henderson, Victoria. / Easy as 4-AT: Improving Delirium Screening in Acute Elderly Admissions with a Targeted Educational Intervention. Poster session presented at British Geriatric Society Autumn Meeting Scotland 2018, Edinburgh, United Kingdom.
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abstract = "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.",
keywords = "4AT, education, infographic, video, delirium, elderly, dr gray, NHS Grampian, physiology",
author = "Conor Cooper and Alexandra Hunter and Jeffrey Handyside and Scott, {Derek Anthony} and Victoria Henderson",
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N2 - 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.

AB - 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.

KW - 4AT

KW - education

KW - infographic

KW - video

KW - delirium

KW - elderly

KW - dr gray

KW - NHS Grampian

KW - physiology

M3 - Poster

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