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Implementing an inpatient postpartum depression screening, education, and referral program: a quality improvement
Eynav Elgavish Accortt1, Lubaba Haque2, Olusinmi Bamgbose3
1Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA (Dr Accortt, Mses Haque and Buttle, and Dr Kilpatrick); Department of Psychiatry, Cedars-Sinai Medical Center, Los Angeles, CA (Drs Accortt and Bamgbose); Reproductive Psychology Program, Cedars-Sinai Medical Center, Los Angeles, CA (Drs Accortt and Bamgbose).
Background:
Perinatal mood and anxiety disorders are common and may interfere with pregnancy, delivery, and the postpartum period. Best practice includes symptom screening, patient education, and appropriate referrals; however, many hospitals struggle to identify and support perinatal mood and anxiety disorders patients.
Objective:
Therefore, the Cedars-Sinai Postpartum Depression Screening, Education and Referral Program was initiated and evaluated.
Study Design:
Using the Standards for QUality Improvement Reporting Excellence 2.0 guidelines, we reported outcomes (N=19,564 deliveries) from 4 interventions: (1) nurse-champion training; (2) use of the 9-item Patient Health Questionnaire-9 in the postpartum unit; (3) a series of brief in-service trainings; and (4) a 10-minute video training. We collected data including nurse feedback, screening rates, screen-positive rates, and social work consultation rates.
Results:
The 4 interventions increased: (1) nurse-champion screening comfort and perinatal mood and anxiety disorder knowledge; (2) Patient Health Questionnaire-9 screening rates from 10% to 99% and screen-positive rates from 0.04% to 2.9%; and (3) rates of social work consultation from 1.7% to 8.4%.
Conclusion:
Quality improvement results from the first 3 years of the program suggest that 4 interventions improved screening rates, screen-positive rates, and social work consultation rates. Future work will focus on method of screening, patients at highest risk of perinatal mood and anxiety disorders, and ongoing nurse training.
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