Identifying and Connecting Food Insecure Families to Resources in the Inpatient Setting

Purpose/Objectives: Food insecurity (FI) is defined as the state of being without reliable access to a sufficient quantity of affordable, nutritious food. In San Diego County, 1 in 7 adults and 1 in 5 children face FI with Black, Indigenous, and People of Color (BIPOC) communities disproportionately affected. A pilot study conducted at our institution found that approximately 20% of patients admitted to the Pediatric Hospital Medicine (PHM) service had FI, signaling the urgency to standardize a screening and resource delivery workflow.

SMART

Aim: Within 9 months, >50% of patients admitted to the PHM service will be screened for FI and resources offered to >80% of families identified with FI.

Design/Methods: A validated 2-question screening tool and Best Practice Advisory (BPA) were created in the electronic medical record (EMR) in previous cycles of the pilot study; the BPA reminded clinicians to offer a social work (SW) consult for positive FI screens. An interdisciplinary team of physicians, nurses, dietitians, and social workers collaborated to create the best workflow and review data monthly. Plan-Do-Study-Act cycles were initiated in November 2020 (week 0). C1: Resident attitudes assessment, education on importance of screening, and training on screening workflow. C2: PHM faculty training session on the screening workflow; Ishikawa performed to assess barriers. C3: FI patient column added to EMR patient list as visual reminder. C4: SW BPA revised to enhance visibility and clinical decision support. C5: Link to FI screening questions added to H&P note template. C6: EMR dot phrase created to add resources to discharge After Visit Summary (AVS) in English and Spanish for positive screenings.

Results: Baseline pilot data showed an average of 4.7% of patients admitted to PHM were screened for FI (weeks -11 to -1). After C3, a consistent upward trend was seen with special cause variation noted. Multiple center line shifts occurred with a new average of 82% screened beginning in April 2021 (Week 20), sustained for almost two months thus far (Figure 1). After revising the BPA to improve visibility and SW consult recommendation, there was a dramatic increase in resource delivery, again seen after creation of dot phrases for resources in the AVS. In January 2021, only 36% of identified families received resources, which increased to 68-85% by March-May (Figure 2).

Conclusion/Discussion: We surpassed our aim to increase the rate of inpatient FI screening in patients admitted to PHM. We neared our aim of food resources offered to patients with FI but need more data to show sustainability. Adding a link to FI screening in the H&P note template showed the greatest change. Our next PDSA cycles will focus on streamlining the workflow for providing resources and implementing a tiered system to prioritize patients for SW evaluations.