Food Insecurity Screening and Referral in Pediatric Inpatient Units: A Quality Improvement Project

Purpose/Objectives: Food insecurity (FI) is defined as limited or uncertain access to adequate food. According to the American Academy of Pediatrics (AAP), one in six children lives in a food insecure household. The AAP recommends screening for FI at health maintenance visits or sooner if indicated. Due to the COVID-19 pandemic, there was an increase in FI and many children missed health maintenance visits. We aimed to increase the percentage of pediatric patients screened for FI in the hospital setting from 0% to 75% and to improve the percentage of screen-positive patients referred to food services and resources from 0% to 70% in a period of six months.

Design/Methods: From August 2020, an interdisciplinary group of pediatric hospitalists, residents, social workers, and food navigators convened to address food insecurity in the inpatient setting, which included the well-baby nursery, general pediatrics unit and pediatric critical care unit (PCCU). Baseline data were collected via manual chart review from September 2020 to November 2020. The model for improvement was used as improvement methodology and a key driver diagram to guide improvement efforts. Screening for FI was done using the validated and AAP-recommended Hunger Vital Sign questionnaire. The following plan-do-study-act (PDSA) cycles were initiated at various stages of the project: FI educational conference, FI workflow, FI screen in admission note, progress note and handoff, FI in monthly resident orientation, food navigator flyers in resident workroom and regular multidisciplinary meetings throughout the project. Our outcome measure was referral of screen positive patients to food navigators and process measures were FI screening rates and referral of screen positive patients to social work. Data were tracked continuously using run charts. Statistics were conducted using STATA version 16.

Results: Of the 757 patients admitted to the inpatient units from December 2020 to May 2021, 649 (86%) were screened for FI. The rate of FI screening in the well-baby nursery was higher than the general pediatrics unit and PCCU (89% versus 81%, P=.001). Screening rates increased from 0 to a median of 97% in the well-baby nursery and 78% in the general pediatrics unit and PCCU (Figure 1a & 1b). A total of 28 (100%) families who screened positive were referred to social work (Figure 1c) and 26 (92%) were referred to food services (Figure 1d). Referral outcomes are presented in Figure 2.

Conclusion/Discussion: Using quality improvement methodology, we improved FI screening in the hospital setting and connected 26 patients who screened positive to food services. Future interventions should focus on the families who were connected to food services to identify gaps and barriers in using those services and determine persistence of FI and its impact on the pediatric population.