Year 2021
October 2021


Abstract Title
A pilot study of Nurses using 4A’s Test (4AT) to detect delirium among elderly patients in a General Surgical Ward Setting.



Tan Tock Seng Hospital1

Background & Hypothesis

Delirium is known to have adverse effects on patients’ outcomes. The major barrier towards delirium prevention is poor detection. We launched a Delirium Bundle pilot project in a surgical ward. 4 A’s test (4AT) was introduced to the nurses to screen for delirium.

The aim of this study is to assess the accuracy of 4AT for delirium detection and identify risk factors for developing delirium among the surgical elderly patients.


Surgical patients meeting the criteria were first screened by ward nurses. Those with 4AT positive (score >/= 4) were further evaluated for diagnosis of delirium. We collected the patients’ demographic data and clinical outcomes retrospectively from electronic nursing and medical records. t-test and Chi-Square were used for data analysis.


188 patients (mean age = 76)  met the criteria for 4AT screening between October 2020 to March 2021. 57 patients (30%) were 4AT positive and 131 patients (70%) were 4AT negative. Of the 4AT positive patients, 39 (68%) were confirmed to be in delirium. For patients who were not diagnosed with delirium, high 4AT score were contributed by patients’ underlying dementia. The data also indicates age and underlying dementia are important risk factors for developing delirium (p < .002 and p < .001). In this study, the sensitivity and specificity of 4AT is 97% and 86% respectively.

Discussion & Conclusion

4AT is an effective and easily adaptive tool for nurses to identify patients with delirium in this study. Routine ward-based screening for delirium in high-risk populations can improve delirium detection and patient outcomes.