742 - Addressing Social Needs During Pediatric Hospitalization: A Quality Improvement Initiative

Health outcomes for hospitalized children are influenced by social needs like food insecurity, housing and transportation instability. Still, many inpatient medical teams do not routinely screen for or respond to those needs prior to discharge even though doing so could optimize transitions from hospital to home.

Objective:

To increase the percentage of hospitalized children whose caregivers are screened for social needs from a baseline of 0% to 70% in 24 months.

Design/Methods:

We used the Model of Improvement for this single-center quality improvement (QI) initiative at a large, urban children’s hospital on one general pediatrics inpatient unit starting 1/2021. Our multidisciplinary team included physicians, nurses, a parent, a social worker, and members of our support staff (e.g., child life). Key drivers included: 1) employee engagement and buy-in, 2) reliable integration for administering screening tool and response algorithm into workflow, 3) caregiver engagement and buy-in, 4) effective communication between care team members, and 5) an efficient referral process for those with identified needs. We performed multiple plan-do-study-act (PDSA) cycles mapped to these drivers. We initially used a paper screening tool to assess social needs (e.g., transportation) and then moved to electronic screening. We used statistical process control charts and their established rules to track the impact of interventions over time to identify special cause variation to evaluate our measures. We tracked the percent of caregivers screened for social needs, number of identified needs, and number of referrals (e.g., social work) made if a need was identified. As a balancing measure, we tracked patient family experience.

Results:

Total admissions to the unit ranged from 39-182 patients per week during the study. We increased social needs screening from 0% to 30% over 24 months (Figure 1). 35% of caregivers identified ≥1 social need; of those, 28% had social work or support staff referrals. There were no changes to patient family experience ratings. Paper screening was unreliable and negatively affected by high census. The most successful PDSAs were integration of screening into team member workflows and electronic screening.

Conclusion(s):

Inpatient social needs screening and response may optimize transitions from hospital to home. Electronic screening was key to promoting reliable screening in our inpatient setting. While we have not yet achieved our goal screening rate, the QI work continues, aligning with a push for standardized approaches to social needs screening across the institution.