Redesigning Inpatient Postpartum Care to Achieve Universal Depression Screening and Early Connection to Behavioral...

Area of Science:

• Obstetrics and Gynecology
• Psychiatry
• Nursing Science

Background:

• Perinatal depression affects many postpartum individuals.
• Universal screening and timely behavioral health referrals are crucial for maternal well-being.
• Current inpatient screening rates and referral pathways are often suboptimal.

Purpose of the Study:

• To assess a nursing-led inpatient workflow's impact on perinatal depression screening and behavioral health referrals.
• To evaluate the implementation process using the RE-AIM framework.

Main Methods:

• Retrospective cohort study of postpartum patients (n=522) pre- and post-intervention.
• Standardized nursing-led workflow using Edinburgh Postnatal Depression Scale (EDPS).
• Assessed screening completion, positive screens, social work, and reproductive psychiatry referrals.

Main Results:

• Screening completion increased from 25.7% to 95.0% (p<0.001).
• Positive screens rose from 1.5% to 6.8% (p<0.001).
• Social work referrals increased from 34.6% to 47.7% (p=0.002), with intervention associated with higher odds (aOR 1.56).

Conclusions:

• A nursing-led workflow achieved near-universal inpatient perinatal depression screening.
• The workflow improved identification of depressive symptoms and increased behavioral health referrals.
• This feasible, acceptable, and scalable model can be integrated into standard hospital practice.