A&Ox4
Formal Definition
Alert and Oriented times 4: a cognitive assessment indicating the patient is oriented to person (knows who they are), place (knows where they are), time (knows the date/year), and situation/event (understands why they are in the hospital).
How It's Used on the Ward
"A and O times four" — the baseline neuro check on every patient. Dropping to x3 or x2 flags cognitive change.
Example
""On admission: A&Ox4, conversational, appropriate. Next morning: A&Ox2 — knows his name but thinks he's at home and can't state the year. This is acute delirium until proven otherwise.""
Clinical Context
A&Ox4 is a floor, not a ceiling of cognitive assessment. Full orientation does not mean a patient has capacity or is free from subtle delirium. Use the 3D-CAM or a bedside cognitive test when concerned. Orientation to "situation" (why am I here?) is often the first to go in early delirium — patients can still know their name while being profoundly confused.