Leveraging Technology and Workflow Optimization for Health-Related Social Needs Screening: An Improvement Project at a Large Health System.

BACKGROUND: The collection of health-related social needs (HRSN) data at one large health system has historically been inconsistent. This project was aimed to increase annual HRSN screening rates by standardizing data collection in the electronic health record (EHR) through optimized clinical workflows. METHODS: The authors designed a standard screening questionnaire in alignment with the Accountable Health Communities model, and they conducted interviews with eleven US-based health systems and one medical center on best practices for ambulatory HRSN screening and interventions, which identified five possible methods to administer the questionnaire. After testing, the authors opted to send questionnaires to patients through the patient portal three days prior to an ambulatory visit. For inpatients, in-person interviews were implemented. Staff implementing the updated processes included registered nurses, social workers, preventive health coordinators, and community health workers. RESULTS: The annual screening rate for all active ambulatory patients increased from 0.4% to 15.9% (p < 0.001), and 10.7% of all patients had at least one health-related social need. The annual screening rate for inpatients was estimated to be zero at baseline and increased by 66 percentage points (p < 0.001). The most prevalent health-related social need in both settings was financial resource strain, followed closely by food insecurity. CONCLUSION: Well-designed interventions and technology support were effective in achieving improved screening and data collection. Leadership support, building interventions within preexisting workflows, and ensuring standard data capture in the EHR were key factors leading to successful process improvement.

Using Quality Improvement Science to Promote Reliable Communication During Family-Centered Rounds.

BACKGROUND AND OBJECTIVES: Family-centered rounds (FCR) can lead to improved communication, satisfaction, and care delivery. However, FCR are variable in practice. Our primary goal was to implement and sustain consistent communication practices during FCR (a subset of all rounds in which parents were present) for patients on a pediatric hospital medicine service. We aimed to achieve 80% reliability for the following FCR practices: (1) discussion of risk factors and prevention strategies for hospital-acquired conditions (HACs), (2) discussion of discharge planning, and (3) asking families for questions. METHODS: Research assistants observed FCR on a pediatric acute care unit at an academic medical center and recorded if the rounding team discussed HAC risk factors, discussed discharge, or asked families for questions. Using the Model for Improvement, we performed multiple plan-do-study-act cycles to test and implement interventions, including (1) standardized note templates, (2) education via peer-led group discussions and team e-mails, and (3) routine provider feedback about performance. Data were analyzed by using statistical process control charts. RESULTS: From October 2017 to April 2019, reliability increased to >80% and sustained for (1) discussion of HAC risk factors (increased from 11% to 89%), (2) discussion of discharge planning (from 60% to 92%), and (3) asking families for questions (from 61% to 87%). Peer-led physician education, reminder e-mails, and physician engagement were the most impactful interventions corresponding to centerline shifts. CONCLUSIONS: Using multiple interventions, we achieved and sustained improvements in key communication-related elements of FCR. Future work will focus on determining if improved practices impact clinical outcomes.

Removing Race From Hyperbilirubinemia Guidelines Is Not Enough.

This Viewpoint discusses the complexities of race-conscious medicine and the importance of more explicit and attentive guidance in treatment recommendations.