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HEEADSSS Up: Evaluating the Efficacy of a Blank Proforma in the Use and Documentation of an Adolescent Psychosocial
1CHI @ Crumlin, Children's Health Ireland at Crumlin, Dublin, Ireland.
Background:
Adolescence is typically seen as a "healthy" period in a person's life, free from illness. The World Health Organisation (WHO) estimates that 1.7 million adolescents die every year because of preventable causes such as suicide, injuries, and violence. The aim of this quality improvement initiative was to assess and improve the use and documentation of the psychosocial risk assessment tool; HEEADSSS, amongst non-consultant hospital doctors (NCHDs) in a paediatric tertiary centre emergency department (ED).
Methods:
This was a mixed method quality improvement initiative carried out over three phases in paediatric tertiary centre ED. Educational interventions were implemented and their efficacy assessed.
Results:
There was a 277% (n = 9 increased to n = 34) improvement in the use and documentation of HEEADSSS in the post intervention phase of the study. Participants who had undertaken the intervention were significantly more likely to have either a partially or fully completed HEEADSSS assessment compared to those who had not (odds ratio [OR] = 5.24, 95% confidence interval [CI]: 3.45-7.75, p < 0.001; n = 409). Additionally, the odds of having a fully completed HEEADSSSassessment were significantly higher among those who received the intervention (OR = 4.08, 95% CI: 1.90-8.75, p < 0.001; n = 409). Clinical presentations synonymous with psychosomatic illness, such as chest pain, abdominal pain and headaches were more likely to have a HEEADSSS done following the intervention phase.
Conclusion:
The results demonstrate the efficacy of simple, accessible and education focused interventions. There is little documented in current literature about the efficacy of a proforma. In the field of adolescent medicine, there is a call for a multi-sectorial approach to be adapted, encompassing the educational, emotional, and financial needs of adolescents. Global health promotion strategies need to adjust to a prevention paradigm, focusing on the origin of adult mortality.
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