Implementing an EMR-based Health-related Social Needs Screen in a Pediatric Hospital System.

INTRODUCTION: There is growing recognition of the need for effective screening methods and delivering interventions to address health-related social needs (HRSN) in hospital systems, but few studies exist on implementing such a wide-scale undertaking. This article describes the implementation and preliminary findings of a phased roll-out of an institution-wide HRSN screening. METHODS: We describe the HRSN implementation and data tracking procedures. RESULTS: During the first 13 months of the roll-out, 62,315 patient encounters from multiple clinics were eligible for screening, and 52,331 (84.0%) completed the screening. Twelve percent of patients had at least one HRSN need, and 3.5% of those had an urgent need and thus received a social work consult. CONCLUSION: Implementation of the first phase of an institution-wide HRSN screen resulted in high screening and follow-up rates among those with urgent needs, demonstrating feasibility across different clinic settings.

Transcranial magnetic stimulation--may be useful as a preoperative screen of motor tract function.

UNLABELLED: Transcranial motor stimulation with noninvasive cortical surface stimulation, using a high-intensity magnetic field referred to as transcranial magnetic stimulation generally, is considered a nonpainful technique. In contrast, transcranial electric stimulation of the motor tracts typically cannot be done in unanesthesized patients. Intraoperative monitoring of motor tract function with transcranial electric stimulation is considered a standard practice in many institutions for patients during surgical procedures in which there is potential risk of motor tract impairment so that the risk of paraplegia or paraparesis can be reduced. Because transcranial electric stimulation cannot be typically done in the outpatient setting, transcranial magnetic stimulation may be able to provide a well-tolerated method for evaluation of the corticospinal motor tracts before surgery. METHODS: One hundred fifty-five patients aged 5 to 20 years were evaluated preoperatively with single-stimulation nonrepetitive transcranial magnetic stimulation for preoperative assessment. RESULTS AND CONCLUSIONS: The presence of responses to transcranial magnetic stimulation reliably predicted the presence of responses to transcranial electric stimulation intraoperatively. No complications occurred during the testing, and findings were correlated to the clinical history and used in the setup of the surgical monitoring.