226 - Improving Adolescent Depression Screening Inpatient Using A Standardized PROMIS Screening Tool

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 226
Publication Number: 226.45

Amanda Seibert, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; John M. Morrison, Johns Hopkins All Children's Hospital, St Petersburg, FL, United States

Presenting Author(s)

Amanda Seibert, MD (she/her/hers)

Resident Physician
Johns Hopkins All Children's Hospital
Saint Petersburg, Florida, United States

Background: Nearly 40% of youth committing suicide had contact with a general healthcare provider weeks before their death. Existing literature suggests that the inpatient setting is a key area where adolescents can and should be screened for mental health concerns even when not acutely receiving mental health care. Our institution did not previously perform standardized screening for depression in the inpatient setting.

Objective: Increase screening for depression in adolescents without a primary mental health concern who are admitted to the resident team at Johns Hopkins All Children’s Hospital from 0% to 30% by October 2022.

Design/Methods: We initiated the use of a paper-based screening form (PROMIS Depressive Symptoms–Short Form 8a) and serial Plan-Do-Study-Act cycles to test changes to the process of screening and documenting in the electronic medical record. The primary outcome measure was the percentage of admitted adolescents (ages 12-17) on the resident team who were screened for depression. Individuals were excluded if they could not complete the form independently or if they were already screened for depression as a result of a mental health diagnosis. Residents provided the screening form to eligible patients and documented a clinical score based on the patient’s responses. The care team followed a pathway utilizing this score to facilitate consultation of social work and/or psychology (Fig. 1). PDSA cycles focused on improving the primary outcome, documentation in the EMR, and appropriate consultation with social work and psychology (Fig. 2). Efforts included visual aids in workrooms, education for the resident team with the start of each block, transition from interns to second year resident for screening responsibility, and dedicated clipboard for materials.

Results: Between 5/2022 and 10/2022, 20 adolescents were screened for depression. After initiation of the screener and several PDSA cycles, our median screen rate increased from 6% to 20% (Fig. 3). We identified five adolescents with PROMIS scores suggesting mild or moderate depression that would previously be unrecognized. Social work and psychology were consulted for all eligible patients (n=3). Screening results were documented in the EMR for 85% (n=20) of patients.

Conclusion(s): We increased the screening for and documentation of depression among hospitalized adolescents that would not otherwise have been identified in our previous system. Adolescents at-risk for depression were successfully referred to hospital- and community-based resources. Next steps will focus on expanding this initiative to other hospitalist teams in our institution.
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