Work

Nurse-Driven 4AT Delirium Screen and Outcomes in Hospitalized Older Adults

Year: 2024

Type: article

Abstract: Background Delirium is associated with poor clinical outcomes including morbidity, mortality, prolonged length of stay (LOS), and unfavorable discharge location, yet it is under-recognized in hospital settings due to a lack of routine assessment. The 4AT is a brief validated delirium screening tool. Objective This study aims to determine whether nurse-performed hospital 4AT scores are associated with LOS, discharge location, in-hospital mortality in older adults at an urban US hospital. Methods As part of a quality improvement project, hospital nurses at our institution began routinely administering the 4AT every shift. We analyzed 4AT scores from 5,585 unique older adult (65+) hospital admissions occurring between 11/2022-05/2023. Maximum 4AT scores for each hospitalization were related to LOS, discharge location (home versus non-home), and in-hospital mortality using logistic regression models. Results 89.9% of patients received at least one 4AT score during hospitalization. Mean patient age on admission was 75.3 years (SD= 7.9). Patients in the study predominantly identified as Black (61.4%) or White (28.0%); 14.9% had maximum 4AT between 1-3, and 15.2% had maximum 4AT ≥4. The mean LOS increased with increasing 4AT scores. The mean LOS for patients with a maximum 4AT score ≥4 was 11.6 days (SD= 11.8), compared to a mean LOS of 4.8 days (SD= 5.4) for patients with a maximum 4AT score=0. Adjusted logistic regression models revealed an OR of 0.24 (95% CI [0.20-0.30]) for discharge home when comparing patients with 4AT score ≥4 compared to patients whose 4AT score=0. 4AT scores ≥4 were also significantly associated with risk of in-hospital mortality compared to 4AT scores=0 (OR 16.6 95% CI [7.8-35.5]). Conclusions Routinely administering the 4AT tool can help identify those at risk of longer LOS, unfavorable discharge locations, and in-hospital mortality, reinforcing the need for early and effective delirium treatment and implementation of delirium prevention strategies.

Source: Delirium

DOI: 10.56392/001c.115760