The 4AT tool and TIME checklist can be used to aid the diagnosis and management of delirium. These are found on purple paper on all wards. Detailed guidance is contained in the Delirium Diagnosis, Risk Reduction, and Management in Acute Services guideline.

On admission, patients at risk of delirium should be assessed using the 4AT and have part T of TIME completed, with the checklist being used to guide management and care planning. They also require a clinical assessment as to whether or not they already have delirium (this is prompted by TIME).

2024年4月9日 · The TIME checklist should be used to prompt good delirium risk reduction, diagnosis and management – it consists of a 4AT and the 4 steps: Think, Investigate, Manage and Explain & Explore

The 4AT or 4 ’A’s Test is a simple and short (<2 min) delirium detection tool purposely designed for easy clinical use. It does not require special training. The 4AT is the most validated delirium tool in the literature, with 33 diagnostic test accuracy studies involving >6000 patients. It is highly sensitive and specific.

The 4A’s test (4AT): This is a short, four-item tool designed for use in clinical practice. The four items are alertness, cognition (a short test of orientation), attention (recitation of the months in backwards order), and the presence of acute change or fluctuating course.

Use of the 4AT in practice. The 4AT can be used in the following situations: ED or other acute settings as a screening tool for delirium in older people. At home or in care homes when delirium is a concern. Transitions of care. Pre-op delirium & cognitive assessment. Post-op, repeated daily for an appropriate period (usually 3-7 days)

Improved detection of delirium using the 4AT results in a conservatively estimated cost saving of GBP100 per patient. With 731,000 acute, emergency admissions for patients aged 75 and over per year in England alone, and 4AT used in 77% of NHS England acute hospital trusts, this can translate to NHS savings of GBP56,000,000 every year.

Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the Confusion Assessment Method. BMC Med. 2019 Jul 24;17(1):138

The 4AT is a screening instrument designed for rapid initial assessment of delirium and cognitive impairment. A score of 4 or more suggests delirium but is not diagnostic: more detailed assessment of mental status may be required to reach a diagnosis.

On admission, patients at risk of delirium should be assessed using the 4AT and have part T of TIME completed, with the checklist being used to guide management and care planning. They also require a