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Improving Social Risk Factors Screening and Resource Referrals in Hospitalized Pediatric Patients
Grace Ng1, Sonia Joshi1, Adam Bracken2,3
1Medicine-Pediatrics Residency Program, University of Rochester Medical Center, Rochester, New York.
Insights
This quality improvement initiative successfully increased social risk factor screening and resource referrals for hospitalized children. Interdisciplinary teamwork and electronic health record interventions improved care for at-risk pediatric patients.
Area of Science:
- Pediatric healthcare quality improvement
- Social determinants of health in children
- Health informatics in clinical settings
Background:
- Social risk factors significantly impact pediatric health outcomes.
- Inpatient settings offer opportunities to screen for and address social needs.
- Previous referral rates for at-risk pediatric inpatients were 33.8%.
Purpose of the Study:
- To improve screening and resource referrals for pediatric inpatients facing food, housing, or transportation insecurity.
- To increase targeted resource referrals from 33.8% to over 50% within two years.
- To enhance the integration of social risk factor assessment into routine pediatric care.
Main Methods:
- An interdisciplinary team implemented a quality improvement initiative.
- Key interventions included multidisciplinary education and electronic health record (EHR) decision support.
- Daily clinical workflows were adapted to include social risk factor reviews.
Main Results:
- The percentage of at-risk patients receiving resources increased from 33.8% to 63.4%.
- The average percentage of screened patients rose from 48.5% to 89.5%.
- Special cause variation indicated significant improvements in screening and referral rates.
Conclusions:
- Interdisciplinary collaboration is crucial for addressing social determinants of health in pediatric care.
- Targeted electronic health record (EHR) interventions effectively improved social risk factor screening.
- The initiative successfully enhanced resource referral for hospitalized children facing social insecurities.
Introduction:
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.
Methods:
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.
Results:
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%.
Conclusions:
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.
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