329 - Implementing an Inpatient Social Needs Screening Protocol at a Tertiary Children’s Hospital Medical/Surgical Ward

Poster Number: 329
Publication Number: 329.323

Matthew S. Pantell, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Matthew Nordstrom, University of California, San Francisco, School of Medicine, Oakland, CA, United States; Sarah Schechter, Columbia University Irving Medical Center, New York, NY, United States; Nicole Penwill, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Nadia Roessler De Angulo, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Jordan H. Vaughan, University of California San Francisco, San Francisco, CA, United States; Sara M. Aziz, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Nora Pfaff, University of California, San Francisco, San Bruno, CA, United States

Background: Social determinants of health (SDOH) are related to a variety of child health outcomes. While addressing family social needs has been shown to improve child health and reduce healthcare utilization, most of this work has focused on the outpatient setting.

Objective: To implement a protocol for social needs screening and resource provision to support patients and families at an urban tertiary children’s hospital medical/surgical ward.

Design/Methods: We convened an interdisciplinary Social Needs Task Force (SNTF) consisting of nurses, social workers, physician trainees, and hospitalists to develop a standardized screening protocol using Lean quality improvement (QI) methodology. We conducted a pre-implementation survey assessing clinician barriers to screening. After selecting financial strain and food insecurity as initial screening domains, we developed a standardized workflow involving: 1) nurses screening all patients for financial strain on admission (goal 40%); 2) physicians screening patients endorsing financial strain for food insecurity (goal 75%); 3) physicians connecting families endorsing food insecurity to hospital- and community-based food resources. The SNTF implemented education sessions, email reminders, and electronic health record (EHR) visual reminders and tools. We calculated percentages of pre-pilot survey answers. We used P charts to analyze our primary outcomes: the proportion of 1) all patients screened for financial strain; 2) financially strained patients screened for food insecurity. We used chi-squared tests to compare rates of screening documentation in the EHR pre- and post-protocol implementation.

Results: Fig 1 summarizes clinician barriers to screening (Nf56). There were 1,186 patients admitted during the study period (11/1/20-11/30/21). We only saw random cause variation in financial strain screening after our education interventions; however, we saw special cause variation after our EHR interventions (Fig 2). We only saw random cause variation in food insecurity screening (Fig 3). Screening rates for financial strain and food insecurity increased from 2.8% pre-implementation (for both) to 87.5% post-EHR intervention (P < 0.001) and 9.7% post-implementation (P=0.007), respectively. Conclusion(s): Our interdisciplinary SNTF-led QI intervention significantly increased financial strain and food insecurity screening rates. EHR interventions resulted in increases in nurse-led financial strain screening, but physician-led food insecurity screening did not meet the target goal. Lessons from our initiative can help inform inpatient social needs QI efforts at other institutions.
Figure 1
Figure 2