Improving Social Risk Factors Screening and Resource Referrals in Hospitalized Pediatric Patients

Social risk factors significantly influence a child's health. Screening and provision of resources in the inpatient setting are opportunities to help mitigate these negative effects. We undertook a quality improvement initiative to increase the percentage of targeted resource referrals for pediatric inpatients hospitalized for more than 24 hours who screened at risk for food, housing, or transportation insecurities from 33.8% to greater than 50% over the course of 2 years.

An interdisciplinary team, including clinicians, informaticists, social workers, nurses, nurse navigators, and a patient-family advocate, conducted this initiative on our general care units. We identified key drivers of a shared mental model and widespread adoption of screening. Interventions included multidisciplinary education, targeted rule-based decision support in the electronic health record (EHR), and incorporation of review of social risk factors into daily clinical workflows. We tracked our outcome and process metrics over time on control charts, monitoring for special cause variation.

Special cause variation was observed with the percentage of at-risk patients who received a resource improving from 33.8% to 63.4% and the average percentage of patients screened improving from 48.5% to 89.5%.

Interdisciplinary stakeholder engagement and targeted EHR interventions were associated with improved social risk factors screening and resource referral among pediatric patients hospitalized on our general care units.