Universal Depression Screen of Ambulatory Heart Transplant Recipients With Referral for Mental Health Intervention: A Quality Improvement Project.

BACKGROUND: Patients with a heart transplant and depression have higher rates of graft failure and noncompliance. LOCAL PROBLEM: The heart transplant clinic had no standardized approach to assess for depression. METHODS: The heart transplant clinic implemented routine use of the Patient Health Questionnaire (PHQ). INTERVENTIONS: Team members were educated via an online module about depression. A process for depression screening and follow-up was developed and implemented. RESULTS: From July 2018 to February 2019, there were 834 visits; PHQ2 screens were completed during 779 (93%) of those visits with 40 (5%) positive screens. All 40 patients had PHQ9 assessment, with 33 patients (4%) exhibiting moderate or severe depressive symptoms. All 33 patients were provided with mental health resources and received follow-up. Median time to administer PHQ2 was 2 minutes (range 1-3 minutes). CONCLUSIONS: Implementation of universal depression screening in a heart transplant clinic is feasible, identifies patients with depression, and does not add significant clinical burden.