337 - Implementation of Social Determinants of Health Screening in the Pediatric Emergency Department
Monday, May 1, 2023
9:30 AM – 11:30 AM ET
Poster Number: 337 Publication Number: 337.447
Brian Davitt, Northwell Health, Cohen Children's Medical Center, Bethpage, NY, United States; Ronak Patel, Cohen Children's Medical Center, New Hyde Park, NY, United States; Anita Pillai, Cohen Children's Medical Center, New Hyde Park, NY, United States
Resident Physician Northwell Health, Cohen Children's Medical Center Bethpage, New York, United States
Background: Social determinants of health (SDOH) influence health outcomes and are related to Pediatric Emergency Department (PED) utilization. For many families, the PED may be the first and only place they receive healthcare therefore necessitating SDOH screening. Universal screening is the first step in addressing the SDOH that affect our community’s health, allowing providers to identify needs that would otherwise go undiscovered, ultimately leading to improved patient care and population health, and reduced costs. Objective: To develop and implement a SDOH screening tool to be used in the PED, to provide resources as needed to families with positive screens, and to identify barriers to universal screening. Design/Methods: A survey was created using the Health Leads Screening Toolkit which collected demographic information and responses questions in four SDOH domains: assessing access to medical care, access to transportation, food security, and housing security. A research assistant conducted surveys during clinical shifts of two attendings. Descriptive statistics summarized responses. Challenges to screening were identified by individuals who conducted the screens. Results: A total of 317 screens were conducted over a 5-month period. The person being screened was most commonly the patient’s mother (81%), followed by father (28.2%), and grandparent (3.4%). 39.9% of respondents spoke another language besides English at home, most commonly Spanish (51.6%). 33.1% identified as White, 21.8% as Hispanic or Latin, 21.2% as Black or African American, 19.9% as Asian. 0.6% as American Indian or Alaskan Native, and 7.9% either identified as other or preferred not to disclose. Overall, 33.4% screened positive on at least one question. 7.9% screened positive for transportation issues, 11.4% for food insecurity, and 5.0% for housing insecurity. 9.1% had trouble getting medication, either due to issues with money (55.6%), insurance (33.3%), or transportation (11.0%). Challenges to screening included lack of time during clinical shifts and decreased availability of social work staff.
Conclusion(s): SDOH screening in the PED is important to provide the best care possible to patients. One third of families screened tested positive in at least one domain, highlighting the need for universal screening and intervention in the PED. Future steps include continuing to create efficient screening methods to be used in time restricted patient encounters, incorporation of the screen into the EMR, involvement of social work and nursing staff, and creation of a geo-map depicting needs in the communities surrounding our institution.
