262 Training and Use of the 4AT by a Multi-disciplinary Team to Screen for Delirium in the Frail Adult

Background Detection of delirium risk may improve outcomes. We assessed the prevalence of patients at risk of delirium assessed by a trained interdisciplinary team. Methods An interdisciplinary team: dietitian, physiotherapist and speech and language therapist was trained to use the 4AT. Community dwelling patients, identified as frail during triage in a hospital emergency department, were assessed including a 4AT, over a 2 month period. Age, gender, Clinical Frailty Score (CFS), 4AT, Modified Barthel index (mBI), polypharmacy (as defined by 5 or more medications) and presence of hearing or visual impairment were entered onto Excel. Performance of the 4AT was at the discretion of the assessor. Results 150 consecutive patients were assessed. The mean(SD) age was 83(5.1). Female to male ratio was 1.2:1. Mean(SD) CFS was 5.6(1.0). 29(19%) patients did not have a 4AT performed. 63(42%) patients had a 4AT of 1-3. 16(11%) patients had a 4AT of 4 or greater. 42(28%) had a 4AT of zero. Patients with a 4AT 4 or greater were older, mean(SD) age 86(4.2)years. Polypharmacy was present in 10(60%) patients with 4AT 4 or greater and 40(38%) with 4AT less than 4. 10(60%) of patients with 4AT 4 or greater had hearing and visual impairment. 16(15%) patients with a 4AT less than 4 had hearing and visual impairment. 10(60%) of patients with 4AT 4 or greater had a reduction in mBI. 33(31%) of patients with a 4AT less than 4 had a reduction in mBI. Conclusion Interdisciplinary teams can screen for delirium risk in ED. Frail patients at risk of delirium are older, have higher rates of polypharmacy, visual and hearing impairment and functional decline. It is possible to evaluate delirium in ED. Further work is needed to explore the relationship between the 4AT and frailty.