60 Surgical inpatient delirium: a re-audit of the documentation of the 4AT score

Abstract Background Postoperative delirium and perioperative neurocognitive disorder are the commonest postoperative complications in patients over 65. This has implications for brain health, hospital length of stay and incidences of morbidity and mortality. Our aim was to perform a re-audit of the documentation of 4AT scores for surgical inpatients >65 following educational sessions across key ward-based staff (medical, nursing, and allied-health). Methods Using the guidelines for Perioperative Care for People Living with Frailty undergoing Elective and Emergency Surgery from the Centre of Perioperative Care (CPOC) and the British-Geriatric-Society (BGS) as a standard, a re-audit of surgical inpatients >65 was performed on four surgical wards over two weeks. Data was collected on 4AT documentation on admission, day one and day three post-operatively, type-of-surgery, anaesthesia and risk factors for delirium (dementia, polypharmacy, opioid & benzodiazepine use, alcohol excess, ≥2 medical co-morbidities, number of ward moves and surgery >2 hours). Results Of the 55 surgical patients, the average age was 76 (65–93). 32.7% of patients presented for hip fracture surgery (n = 18), 40% abdominal/pelvic surgery (n = 22), 15% other surgeries (n = 15). 35% of patients (n = 19) had baseline 4AT documented preoperatively compared to 25%(n = 9) in the initial audit. 4AT score documentation during admission was 47.3%(n = 26) compared to 33%(n = 11). ≥2 surgical risk factors for delirium were found in all patients. The incidence of delirium was 14.5% with eight patients having a 4AT score > 4. Patients who developed delirium had 3–8 risk factors. Four of eight patients with delirium had pre-existing cognitive impairment and/or dementia. Conclusion There was an increase in frequency of 4AT assessments as a delirium screening tool in our cohort following successful collaboration between medical, surgical, anaesthesia, nursing and allied-health staff. Regular educational sessions to maintain awareness and screening of delirium peri-operatively in surgical patients >65 will be a focus for continued quality improvement.