Recognising Delirium

Signs and symptoms of delirium usually begin over a few hours or a few days. They often fluctuate throughout the day, and there may be periods of no symptoms. Symptoms can worsen during the night when it’s dark and things look less familiar. Gathering a history from the patient’s family or carers who know the person is essential and should confirm that there is an acute change from the person’s usual mental state and behaviour. Early identification and notification at the handover of patients at risk are important so that effective interventions can be put in place. Prompt diagnosis and timely treatment of underlying causes are important for reducing the severity and duration of delirium, and the risk of complications that arise from it(2). A variety of screening tools are used in Emergency Departments and out-of-hospital settings to assist in the early detection and recognition of delirium SAAS paramedics and ICPs will be implementing the use of the 4AT Rapid Clinical Test for Delirium in patients who are presenting with or at risk of developing delirium. Ambulance Officers are not required to use this tool however it is good to have an overview of the assessment process that is undertaken. Below are the 4AT charts paramedics and ICPs use to assess the patient. The chart is available for use by paramedics and ICPs in the SAAS clinical app.