Background Delirium is a prevalent issue affecting older patients in acute hospitals. National guidelines mandate that all patients >65 years old admitted to an acute hospital setting are screened for delirium. Prompt assessment and management of delirium is vital in delivering optimal care to the older patient. In our institution, delirium can be under recognised and not assessed routinely as part of the medical admission. Our aim was to assess delirium documentation rates and utilising the 4AT as part of the acute medical admission in a service development project. Methods A retrospective assessment of patient demographics and documentation of delirium and 4AT in the medical admission was carried out for January, February and March 2023 and compared to the same 3-month period in 2024 post set up of a new specialist geriatric ward (SGW) as part of a service development project. This was in tandem to targeted interventions for improving delirium education and management. Results Mean age was 83 years in both groups. 11% (18/157) in the cohort pre SGW and 30% (40/134) post setup of the SGW had a diagnosis of dementia. 13% (20/157) in the pre SGW cohort had delirium documented in the admission note and 23% (31/134) post. 24% (32/134) had a 4AT documented in the admission note post SGW setup compared with 6% (10/157) previously. Conclusion There was suboptimal documentation of the 4AT and delirium in the acute medical admission note. An acute medical admission proforma is being developed and implemented in our institution which will include a 4AT delirium screening tool. We will reassess this in 6 months’ time to ascertain whether there is an improvement in delirium and 4AT documentation. We will also give education to the medical NCHD group carrying out the admissions to emphasise the importance of utilising the 4AT and delirium documentation.

中文翻译：

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谵妄评估和记录作为急性入院的一部分


背景 谵妄是影响急症医院老年患者的一个普遍问题。国家指南要求对所有入住急症医院的 >65 岁患者进行谵妄筛查。及时评估和管理谵妄对于为老年患者提供最佳护理至关重要。在我们的机构中​​，谵妄可能未被充分认识，也没有作为入院的一部分进行常规评估。我们的目的是评估谵妄记录率，并利用 4AT 作为服务开发项目中急性入院的一部分。方法 对 2023 年 1 月、2 月和 3 月入院时的患者人口统计数据和谵妄和 4AT 记录进行回顾性评估，并与 2024 年新专科老年病房 (SGW) 设立后的 3 个月期间进行比较作为服务开发项目的一部分。这与改善谵妄教育和管理的有针对性的干预措施同时进行。结果 两组的平均年龄均为 83 岁。在 SGW 之前的队列中，有 11% (18/157) 和 SGW 设置后的 30% (40/134) 被诊断为痴呆症。 SGW 前队列中有 13% (20/157) 的人在入院记录中记录有谵妄，入院记录中记录有 23% (31/134) 的人出现谵妄。 24% (32/134) 在 SGW 设置后的录取通知书中记录了 4AT，而之前这一比例为 6% (10/157)。结论 急性入院记录中 4AT 和谵妄的记录不理想。我们机构正在制定和实施急性入院形式，其中包括 4AT 谵妄筛查工具。我们将在 6 个月后重新评估这一点，以确定谵妄和 4AT 文档是否有所改善。 我们还将向负责入院的 NCHD 医疗小组提供教育，强调利用 4AT 和谵妄记录的重要性。