Barriers to implementing bedside nursing screening for health-related social needs in surgical patients: An explanatory sequential mixed-methods study

Health-related social needs are increasingly recognized as key drivers of surgical outcomes, yet completion of bedside health-related social need screening remains inconsistent. Substantial missingness in data limits the ability to identify and address social risk in surgical populations. This explanatory sequential mixed-methods study aimed to characterize factors influencing completion of the bedside health-related social need screening among patients undergoing major elective surgery.

We conducted a mixed-methods study in 3 hospitals within a statewide health system. In the quantitative phase, we analyzed patterns of missingness in health-related social need screening among patients undergoing major elective surgery. In the qualitative phase, we conducted semistructured interviews with bedside nurses and nurse managers using purposive sampling. Interviews were transcribed and analyzed using thematic content analysis. The findings from these 2 strands were mixed using meta-inference to synthesize integrated results.

Among 1,172 patients, 52% had missing data in at least 1 health-related social need domain. Fourteen participants (12 nurses and 2 nurse managers) were interviewed for the qualitative strand. There were 3 major themes that emerged: multilevel communication discrepancies, patient-related factors, and areas of improvement. The mixed-methods integration of these findings revealed that inconsistent handoffs, coupled with a lack of oversight, contributed to the high degree of missingness. Further exacerbating the discrepancy in insurance status were patient-related factors including postanesthesia mental status, language barriers, and reluctance to disclose sensitive information. Recommendations for training, built-in reminders, or offloading the health-related social need task to increase compliance were found as solutions to improve fidelity and reduce bias in screener completion.

Completion of the bedside health-related social need screener was hindered by multilevel communication gaps, patient-related factors, and workflow constraints. Targeted implementation strategies, including enhanced training, system-level accountability, and optimization of screening timing and ownership, may improve screening fidelity and enable more effective identification of social risk in perioperative care.