Early Screening Algorithm for Depression After Stroke (E-SAD)

Abstract

Problem: Post-stroke depression (PSD) is common and associated with poor functional recovery, decreased quality of life, and increased mortality. At a community hospital, less than 10% of patients admitted for stroke are screened for post-stroke depression. This practice is not in compliance with the American Heart Association ischemic stroke guideline recommendations. Purpose: The purpose of implementing this quality improvement project was to establish the feasibility of an evidence-based post-stroke depression screening algorithm in a community hospital. In addition, this project sought to provide early interventions to support patients’ psychological wellbeing. Methods: A PSD screening algorithm, was created for this quality improvement project incorporating the Patient Health Questionnaire-9 (PHQ-9) depression screening tool. The PSD algorithm establishes screening score ranges for depression severity and recommends specific actions based on the score to promote patient psychosocial wellbeing. Action items included: providing patient education on post-stroke depression, updating the primary health care provider of the patient’s screening results, outpatient psychiatry referral, inpatient psychiatry referral, and the consideration of starting an antidepressant medication. Patients were considered eligible to have the algorithm applied if they suffered a new ischemic stroke, were hospitalized on the stroke unit, and did not meet exclusion criteria (aphasia, critical illness, hospice, dementia, non- English speaking, and patient refusal). Results: Charts of 65 patients admitted with ischemic stroke were audited between August 30, 2020 and December 1, 2020. Of the 44 ischemic stroke patients admitted, 31 (70.46%) were assessed using the PSD algorithm, by evidence of documentation in the electronic health record PHQ-9 flowsheets. Of those 31 patients, 19 (43.18%) patients were screened with the PHQ-9 while the rest met exclusion criteria. Of the patients screened with the PHQ-9, 13 patients had a screening score indicating no depression, 4 had mild depression symptoms, and 2 patients had moderate to high depression symptoms. The median PHQ-9 score was a 3. Conclusion: Screening for post-stroke depression is feasible in a community hospital setting. Implementing a PSD screening algorithm creates greater awareness of poststroke depression and increases psychosocial support after hospitalization.