A Quality Improvement Project to Enhance Mental Health Responsiveness in a Pediatric Heart Transplant Clinic

Purpose/Objectives: Identifying and managing mental health disturbances is particularly important among pediatric cardiac patients, who experience depression and anxiety at higher rates than their healthy peers (Butts et al., 2020; Dew et al., 2015). To this end, a quality improvement methodology was used to enhance mental health responsiveness by assessing the impact of screening and subsequent intervention on clinical outcomes within a cardiac department at a large Midwestern children’s hospital.

Design/Methods: Patients between the ages of 12 and 22 receiving cardiac services were offered mental health screening, including the Patient Health Questionnaire 9-item scale (PHQ-9) and the Generalized Anxiety Disorder 7-item scale (GAD-7). If a patient’s score on either measure was elevated or suicidal ideation was endorsed, either social work or psychology immediately met with patient in clinic to provide a brief behavioral intervention and/or referral to additional services.

Results: A total of 7 patients were screened during their regular scheduled clinic visits, and subsequently re-screened during a follow-up care visit (M=234.86 days later, SD=197.63 days) due to an elevated score or verbalized suicidal ideation at initial screening. Paired sample t-tests indicated a significant reduction in depression scores at the time of the re-screen with a large effect size ([M=3.57, SD= 2.15], t(6)= 4.40, p=.011, Cohen’s d= 1.66) and a significant reduction in anxiety scores at the time of re-screen, also with a large effect size ([M=4.43, SD= 3.21], t(6)= 3.65, p=.011, Cohen’s d= 1.38).

Conclusion/Discussion: Findings led to a larger expansion of mental health screening with the cardiology department at large, thus improving quality of patient care. Notably, these findings are limited by the absence of standardized screening intervals and the small sample size.