PC3091: Screening for Social Determinants of Health in the Pediatric Critical Care Setting, a Quality Improvement Project

Purpose/Objectives: It is increasingly recognized that an association exists between social risk factors and poor health outcomes in children. However, social risk factors are rarely evaluated during admission to the hospital for critical illness. Social determinants of health (SDOH) screening tools have been used previously at our institution, in both inpatient and outpatient settings, with variable adaptation. A prior quality improvement (QI) initiative was conducted from October 2020 through April 2021 to introduce screening for SDOH in patients admitted to the pediatric critical care unit (PCCU). However, the project was paused intermittently and ultimately halted in the setting of Covid-19 surges and personnel turnover. Our purpose in re-implementing this project beginning in September 2021 was to demonstrate that screening for social needs is 1) feasible in the pediatric critical care setting and 2) can be used as a tool to connect critically ill patients and their families with needed resources.

Design/Methods: A multidisciplinary quality improvement project was re-introduced at a tertiary care PCCU in an urban setting. A workflow was developed to integrate screening for SDOH into the admission process. Providers were trained to respond appropriately to positive screens. Monthly initiatives were conducted to improve uptake of screening. Exclusion criteria for screening included patient age >21 years, preferred language not one of nine available on screener, screening already completed in the 6 months prior to admission, or patient required ongoing active medical stabilization. A standardized, 10-item optional self-administered screener was given to families and collected by the medical provider after completion. Rates of screening in the intervention period from 9/24/21 - 4/7/22 were compared to a 1-month control period from 8/27/21 - 9/23/21 during which no quality improvement interventions were taken.

Results: Rates of screening fluctuated month-to-month (Figure 1), but overall improved fourfold from 1% of eligible admissions in the control period to 4% during the intervention period. Of those screened during the intervention period, 32% were found to be positive for at least one unmet social need. 100% of patients who screened positive were provided with resources to address the identified need(s).

Conclusion/Discussion: While rates of screening were variable, QI interventions were overall successful at increasing screening for SDOH in the PCCU setting. Interpretation of screening results is limited due to small sample size. However, the 32% positivity rate suggests a potentially significant burden of unmet social needs among our patient population. A strength of this project was that all patients and families who reported unmet social needs on SDOH screening were provided with appropriate resources. Further work is in progress to continue to improve incidence of screening and patient access to resources.