Screening for Social Needs in Critically Ill Patients: Addressing More Than Health Conditions

Purpose/Objectives: The County Health Rankings estimates medical care accounts for only 10-20% of modifiable health factors. The remaining factors are attributed to various other determinants of health, including basic or social needs. Eliminating inequities in health outcomes requires innovation in how children with unmet needs are identified. The National Academies of Sciences, Engineering, and Medicine proposed a framework to integrate patients’ social needs with health care delivery. This framework begins with increasing awareness of social risk. Screening tools have been validated for identification of unmet social needs in pediatric outpatient offices. Recognition that patients with unmet social needs frequently have difficulties with outpatient follow up has led to efforts to screen in the acute care and inpatient settings. Children requiring critical care have greater risk for unmet social needs than the general population, but no study has yet utilized screening to identify unmet social needs in the pediatric critical care patient population.

We seek to develop and optimize a standardized tool and process for screening for unmet social needs in the critical care patient population at Cincinnati Children's Hospital Medical Center.

Design/Methods: We applied improvement science to develop and evaluate a social needs screening process, employing patient and staff feedback to inform frequent assessment and process changes. Our screening tool was developed using previously published social needs questionnaires to address all social determinant of health domains. Our course was guided by the experience of a multidisciplinary team including attending physicians, trainees, bedside nurses, advanced practice practitioners, and social workers. This approach allowed for the collaborative development of a process to identify unmet social needs in our patients. We initially limited testing to patients who lived in Hamilton County.

Results: Of 130 patients/caregivers who qualified for screening during the initial 7 months of testing, 66 completed screening (51%). Eighteen declined participation, with 46 missed due to language barriers, technical issues, clinical status, and caregiver availability. Of those who completed screening, 50% identified at least one social need. Fifteen requested assistance (45%) and 33% reported urgent needs. Seven of the patients/caregivers felt uncomfortable being asked social needs questions (11%), specifically when asked their household income. Forty-eight appreciated being asked about social risk during their pediatric intensive care unit admission (73%). Attached figures include run chart and pareto of identified need categories.

Conclusion/Discussion: Critically ill patients are at increased risk of health disparities. Patient acuity is not a limiting factor for identifying social needs. Critically ill patients and caregivers appreciate being asked social needs questions. A standardized approach to screening for unmet social needs in a critical care environment can reduce staff concerns for increased workload and topic discomfort. Future data may on composition of needs may highlight systematic changes to improve population health.