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Nurses' Compliance with Delirium Assessment Protocol in a Tertiary Hospital: A Retrospective Study
Siti Nur I'faaf Binte Mohd Amin1, Siew Hoon Lim1, Min Yi Tan1
1Deapartment of Nursing, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Healthcare (Basel, Switzerland)
|March 28, 2026
Summary
Delirium screening using the 4AT (4
Area of Science:
- Geriatric Medicine
- Neuroscience
- Healthcare Quality Improvement
Background:
- Delirium is a critical neurocognitive disorder in aging populations.
- Early detection of delirium is vital, especially in Singapore's growing elderly demographic.
- The 4AT (4 'A's test) is a validated tool for delirium screening in older adults.
Purpose of the Study:
- To evaluate compliance and timeliness of the Modified 4AT protocol in a Singaporean acute tertiary care setting.
- To identify potential delays in delirium screening impacting diagnosis and management.
- To assess the Modified 4AT's adherence to hospital guidelines for older adult inpatients.
Main Methods:
- Retrospective review of electronic medical records for patients aged 65+.
- Analysis of admissions between June 2022 and June 2023 in a Singaporean acute tertiary hospital.
- Data extraction and review conducted from September 2023 to June 2025.
Main Results:
- 73.5% of 4821 admissions received a 4AT assessment.
- Only 32.9% of assessed patients were screened within the recommended 24 hours.
- The majority of 4AT assessments were performed after the 24-hour window.
Conclusions:
- Suboptimal compliance and delayed Modified 4AT assessments were observed in the acute care setting.
- Timely delirium screening protocols require strengthening to improve care quality for at-risk older adults.
- Adherence to screening protocols may positively impact patient outcomes.
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