Food Insecurity Screening and Referral in a Pediatric Emergency Department

Abstract

Problem: Many neighborhoods surrounding a 20-bed pediatric emergency department in an urban medical center are considered food deserts. This suggests patients receiving care are at high risk of experiencing food insecurity. Previous patient care practices in this pediatric emergency department did not screen for food insecurity. Evidence recommends pediatric patients receiving medical care be screened for food insecurity and connected with the necessary resources to limit associated consequences, such as poor health, developmental risks, and mental health issues. Purpose: The purpose of this project was to implement the Hunger Vital Sign, a 2- item food insecurity screening tool, over 15 weeks in a pediatric emergency department located in an urban medical center. This quality improvement project aimed to identify patients with food insecurity concerns and subsequently refer positive screens to social work for resources. Methods: A quality improvement project was designed to implement the Hunger Vital Sign into a pediatric emergency department’s triage process. Using a standardized nursing note in the electronic health record, the triage nurse screened all patients except those arriving by ambulance or requiring immediate medical attention. Positive screens prompted a social work referral to provide the patient and family resources. Weekly chart audits were completed to track the number and percentage of patients screened in triage, positive screens, positive screens with social work referrals, social work consults before patient discharge, and patients who accepted resources. Results: Run charts were used to analyze data variations of the process and project outcome measures. Results collected during the 15 weeks of project implementation determined triage nurses screened 56% of the 3,607 eligible patients and identified 7% as food insecure. Of the 94% referrals, social work consulted 60% of patients with positive screens, with 89% of patients accepting resources. Conclusions: Following project completion, results were analyzed to evaluate the screening process, efficiency, barriers, facilitators, and sustainability. Conclusions indicate the Hunger Vital Sign effectively identifies food insecurity, and there is a need for food insecurity screening in this pediatric emergency department.