About
About this site
An educational website for nurses and other healthcare staff about ACE-T, a tool for the first hours after a positive delirium screen.
Who maintains this site
This site is maintained by Professor Alasdair MacLullich, Professor of Geriatric Medicine at the University of Edinburgh and a geriatrician at the Royal Infirmary of Edinburgh. He is one of the developers of ACE-T and the 4AT.
His University of Edinburgh profile describes his clinical and academic work. His research profile lists his publications.
ACE-T was developed by a team of nurses and doctors in Edinburgh, Frankfurt and Stanford. See the authors and affiliations.
Evidence and intended use
ACE-T is intended for nurses and other healthcare staff caring for someone with suspected delirium after detection. Use it with clinical assessment, local policy and the wider team.
The evidence described here comes from a development study and a small pilot at three hospitals. The pilot measured staff views and documentation. It did not establish an effect on patient outcomes or validate the four-hour target. Read the results and limitations.
This site uses the manuscript submitted for publication in 2026. A link to the published paper will be added when it is available.
Source and citation
The ACE-T content on this site is taken from the development and pilot paper, which is the source for the tool prompts and pilot results:
The bedside prompts follow Table 1 of the paper, with the 4AT named as the screening tool. The “Why” notes on the tool page are teaching notes written for this site and checked against NICE guideline CG103. A link to the published paper will be added when it is available.
Related resources
Resources maintained by Alasdair include the 4AT, Delirium Academy and Delirium Support. The national guidelines provide further clinical guidance:
- The 4AT: the assessment tool, user guide and training material
- NICE guideline CG103: delirium prevention, diagnosis and management in hospital and long-term care
- SIGN 157: risk reduction and management of delirium
- Delirium Academy: delirium education for healthcare staff
- Delirium Support: information for patients, families and carers
Editorial approach and corrections
The bedside prompts, teaching notes and pilot findings have different sources. The prompts follow the manuscript; the added teaching notes use the clinical guidance linked above. Website edits preserve the wording and scoring of clinical instruments.
The site’s content record documents a manuscript check on 23 September 2026. The language, source links and evidence summaries were updated on 28 September 2026.
The site is maintained by Professor Alasdair MacLullich, University of Edinburgh. To report a content or accessibility problem, email alasdair@the4at.com.
Please do not send identifiable patient information by email.
Accessibility and privacy
The site uses readable text sizes, keyboard-accessible controls, layouts that adapt to phones, a text alternative for every chart, and captions and a transcript for the walkthrough. Animations are reduced if your device asks for reduced motion.
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