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The initial quantitative phase measured doctors\u2019 adherence to the 4AT and the rate of positive 4ATs (\u2265\u20094). The subsequent qualitative phase identified doctors\u2019 main reasons for omitting the 4AT through conventional content analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The quantitative population included 7799 acute admissions (mean age 84, 58.2% female). There was good clinical implementation of the 4AT, evidenced by an overall adherence rate of 83.2% and a rate of positive 4ATs of 14.8% that is in keeping with expected delirium rates in similar settings. The qualitative sample consisted of 875 acute admissions (mean age 84, 56.3% female) with documented reasons for omitting the 4AT. The main barriers to completing the 4AT were: reduced patient alertness, communication barriers (language, deafness, aphasia and dysarthria), prioritising patients\u2019 wellness and comfort (addressing critical illnesses, symptoms, end-of-life issues and promoting sleep), pre-existing cognitive disorders, and unstructured delirium assessments.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Adherence to the 4AT was high and sustainable in both hospitals. Most barriers to completing the 4AT were potentially avoidable. Education about the 4AT in relation to these barriers may improve its implementation.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s41999-021-00582-5","type":"journal-article","created":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T03:02:30Z","timestamp":1637031750000},"page":"163-172","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Barriers to completing the 4AT for delirium and its clinical implementation in two hospitals: a mixed-methods study"],"prefix":"10.1007","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3617-2299","authenticated-orcid":false,"given":"Abdullah A. 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