Universal Screening for Social Determinants of Health: A Quality Improvement Initiative

Abstract

Problem: Social determinants of health (SDOH) have been identified by the World Health Organization (WHO) as “non-medical factors” that affect health outcomes. At a suburban hospital in 2021, 71,463 patients were served in the Emergency Department (ED) with varying social needs, including poverty and lack of transportation. A nurse navigator (NN) role was instituted to address the SDOH needs of these patients, but no screening process to generate referrals to the NN was ever established, requiring the NN to seek out referrals through the EHR. Purpose: The purpose of this quality improvement (QI) initiative was to screen all eligible patients in the ED for SDOH needs using a modified version of the Accountable Health Communities (AHC) screening tool. Those with a positive screen were referred for NN services. Methods: Patients were given a QR code and URL that linked them to AHC Tool in REDcap. Patients used their personal devices to complete the tool in REDCap, which captured their responses; If services were needed, patients provided their name and phone number. Results: A total of 12,022 patients were eligible to complete the voluntary screening tool. The intervention resulted in 206 screening tools being completed, 92 patients identifying at least 1 SDOH need and 42 patients requesting services. Out of the 42 patients requesting services, all were referred to the NN within a week. Eighty-three percent of the total completed screens were executed during quality improvement- project lead (QI-PL) rounds. Conclusions: SDOH screening in the ED is an important and efficacious initiative. The screening process likely requires designation of screening completion with certain designated staff to ensure a more expansive turnout. More immediate NN follow up can occur if the screening tool is built into the EHR and prompts a referral to the NN.