Psychosocial assessment of adolescents and young adults in paediatric hospital settings: patient and staff perspectives on implementation of the e-HEEADSSS.

BACKGROUND: The main causes of morbidity and mortality for adolescents and young adults are preventable and stem from psychosocial and behavioural concerns. Psychosocial assessments can help clinicians to identify and respond holistically to risks and strengths that may impact upon a young person's physical and mental health. Despite broad support at a policy level, the implementation of routine psychosocial screening for young people remains varied in Australian health settings. The current study focused on the pilot implementation of a digital patient-completed psychosocial assessment (the e-HEEADSSS) at the Sydney Children's Hospital Network. The aim of this research was to evaluate patient and staff barriers and facilitators to local implementation. METHODS: The research used a qualitative descriptive research design. Semi-structured interviews were conducted online with 8 young patients and 8 staff members who had completed or actioned an e-HEEADSSS assessment within the prior 5 weeks. Qualitative coding of interview transcripts was carried out in NVivo 12. The Consolidated Framework for Implementation Research guided the interview framework and qualitative analyses. RESULTS: Results demonstrated strong support for the e-HEEADSSS from patients and staff. Key reported facilitators included strong design and functionality, reduced time requirements, greater convenience, improved disclosure, adaptability across settings, greater perceived privacy, improved fidelity, and reduced stigma for young people. The key barriers were related to concerns over available resources, the sustainability and continuity of staff training, perceived availability of clinical pathways for follow-up and referrals, and risks related to off-site completions. Clinicians need to adequately explain the e-HEEADSSS assessment to patients, educate them about it, and make sure that they receive timely feedback on the results. Greater reassurance and education regarding the rigour of confidentiality and data handling procedures is required for patients and staff. CONCLUSIONS: Our findings indicate that continued work is required to support the integration and sustainability of digital psychosocial assessments for young people at the Sydney Children's Hospital Network. The e-HEEADSSS shows promise as an implementable intervention to achieve this goal. Further research is required to determine the scalability of this intervention across the broader health system.

Falling short: examination of the validity of methods used to identify paediatric hospital falls in NSW, Australia.

OBJECTIVE: Hospital falls are a major cause of costly harm. This descriptive epidemiological study reports the results of a data linkage and medical record review to examine the relative utility of these methods for identifying paediatric in-hospital falls. Type of program or service: The study was conducted across two tertiary and quaternary specialist paediatric hospitals in New South Wales (NSW), Australia. METHODS: A retrospective audit was conducted of paediatric falls occurring in hospital between 1 July 2015 and 30 June 2016. Falls were identified using two systems: the Incident Information Management System (IIMS) and medical records coded data (MRCD). These data were linked, and falls were verified using medical record review. RESULTS: Of the 146 in-hospital falls identified, only 28 (19%percnt;) were included in both systems. The IIMS identified 137 falls, with five excluded. The MRCD identified 63 admissions in which falls occurred, with 27 excluded, and screening of clinical notes found 42 falls in the remaining 36 admissions. LESSONS LEARNT: There was a discrepancy in the number of falls identified in the two administrative datasets due to different inclusion criteria. The medical record review provided additional practice-relevant information that was unavailable within the two datasets. This descriptive epidemiological study highlights the value of combining data linkage with medical record review, but also the need for more critical reflection on the methods used to collect and report falls data in Australian hospitals, so that comprehensive and accurate data can be used to inform quality and safety interventions. This analysis will inform improvements to data capture methods and provide data to advise paediatric falls prevention strategies within the NSW paediatric hospital context.