350 - Screening Middle-School-Age Patients For SCD/SCA During Well Visits In A Pediatric Outpatient Clinic

Poster Number: 350
Publication Number: 350.345

Carmen Chavez, Icahn School of Medicine at Mount Sinai, Jamaica, NY, United States; Ramakrishnan Kizhakkancherry Ganesh, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, United States; Amr Ali, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Sahithi Pemmasani, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, United States; Adila Chamavaliyathil, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Carla V. Gonzalez, Icahn School of Medicine at Mount Sinai, queens, NY, United States; Carlos Paredes, Icahn School of Medicine at Mount Sinai, Rego Park, NY, United States; Sara Malakov, Icahn School of Medicine at Mount Sinai, queens, NY, United States; Sarah Lazaros, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Lisa Forman, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, United States; Felicia Fojas, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, United States; Gwen Raphan, Icahn School of Medicine at Mount Sinai, Oceanside, NY, United States

Background: The American Academy of Pediatrics (AAP) published a policy statement in July 2021 focusing on the importance of using 4 screening questions by primary care providers to screen and prevent sudden cardiac death (SCD) and sudden cardiac arrest (SCA) in all children who are about to enter middle school regardless of their athletic status.

Objective: Implement a standardized screening process for SCD/SCA at 11-year-old well child visits at our Tuesday Pediatric Primary Care Clinic by December 2021.

Design/Methods: At the onset of the QI project all providers received an email notifying them of the release of the AAP 2021 SCD/SCA policy statement and requesting they administer a 4-question screening for SCD/SCA for all 11-year-old well visits (PDSA 1). This was followed by the creation of a “smart phrase” with the questions that could be added to a provider note in our EMR (PDSA 2). Subsequently, we sent weekly messages via the EMR to all providers reminding them to screen their 11-year-old patients (PDSA 3). Lastly, the screening questions were embedded in residents' well visit EMR note template (PDSA 4). The charts of all 11-year-olds seen on Tuesdays for well exams in our pediatric primary care clinic from August 31st through December 7th were reviewed to determine the number of patients screened. In addition, we reviewed charts of all referrals to pediatric cardiology 3 months prior to our intervention to determine the rate of SCD/SCA referral as our balancing measure.

Results: During our initial PDSA cycle, no patients were screened. With successive PDSA cycles, we increased the rate of screening to an average of 17% screened during PDSA 2, 72% during PDSA 3 and 70% during PDSA 4. Baseline referral to pediatric cardiology for SCD/SCA risks in the charts reviewed of 11-year-old patients (n=120) in the 3 months prior was 1.7%. None of the patients screened during the QI project  (n=14) were positive for SCD/SCA risk factors.Conclusion(s): Our findings suggest that simply educating providers about the guidelines and asking them to screen was not sufficient to affect change. It was only after adjustments to the EMR were made and weekly reminders were sent, that providers significantly increased their screening for SCD/SCA. We were concerned that increased screening may generate a significant number of unnecessary pediatric cardiology referrals, but we did not observe this. Screening rates remained variable, likely due to time constraints associated with the number and complexity of the questions as well as language barriers, suggesting further strategies are needed for universal adoption within our clinic.
11-Year-Olds Screened For SCD/SCA During Well Visits