Quality Improvement: A Template-Based Approach to HEADSS Assessments for Hospitalized Adolescents

Area of Science:

• Adolescent Medicine
• Quality Improvement Science
• Healthcare Informatics

Background:

• Adolescent hospitalizations are missed opportunities for screening risk behaviors.
• Only 11% of adolescent inpatients had complete HEADSS histories at baseline.
• Inpatient settings present unique challenges due to patient medical complexity.

Purpose of the Study:

• To improve the documentation rate of comprehensive HEADSS (Home, Education, Activities, Drugs, Alcohol, Tobacco, Sexual history, Self-harm, Suicidality, Mood) histories in adolescent inpatients.
• To increase the completion rate from 11% to 31% within 8 months.

Main Methods:

• A quality improvement project was implemented using Plan-Do-Study-Act cycles.
• Interventions included modifying electronic note templates and provider education.
• Key drivers of incomplete histories were identified and addressed.

Main Results:

• The complete HEADSS history rate significantly increased from 11% to 39%.
• Use of confidential notes rose from 14% to 38%.
• Documentation of sexual history improved from 18% to 44%.

Conclusions:

• Implementing note templates in electronic health records can significantly improve adolescent health history documentation.
• Quality improvement initiatives are effective in enhancing comprehensive patient assessments in inpatient settings.