The UMB Digital Archive is getting an upgrade! The upgrade requires a content freeze starting 1/27/25 and is expected to last two weeks. Any new user accounts or submissions made to the Archive during this time will not be transferred to the upgraded site. Contact ArchiveHelp@hshsl.umaryland.edu for questions.
Identifying and Managing Major Depression in the Emergency Department
Abstract
Problem: Major depressive disorder (MDD) is a common and serious medical illness caused by physiological, emotional, and social elements that can be treated and managed. For many adults, the Emergency Department (ED) serves as the safety net for care, reinforcing the importance of addressing MDD when they are present. The ED in Baltimore manages approximately 45,000 patients per year, served as the site for this quality improvement project. Previously, there was no screening protocol for depression or formal education provided to nursing staff to understand root causes of depression affecting patients presenting to the ED. Purpose: The purpose of this quality improvement project is to implement the Patient Health Questionnaire (PHQ-9) screening tool within the Emergency Department to better identify patients at risk for MDD and suicide, and thereby align them with mental health, psychiatry, and social work resources. The review of literature was consistent in their recommendation of utilizing the PHQ-9 as a sensitive indicator for MDD demonstrating consistent benefits of implementation in the ED setting. Methods: The PHQ-9 was performed on patients presenting to the ED with an Emergency Severity Index (ESI) of 2 or greater, via a screening flowsheet by nursing staff. This initiative was implemented over a 15-week period in the Fall of 2023. Chart audits were performed weekly evaluating staff adherence. Multiple data sets were collected including nursing education, as well as chart audits observing the utilization of PHQ-9. Results: Education was provided to nurses with pre and post surveys demonstrating increased familiarity with depression and the PHQ-9, and willingness to use the tool, recognizing the benefit of the education piece to increased utilization. A total of 474 screenings were performed, and 54 patients screened positive. Conclusion: Despite the significant operational barriers, there was increasing utilization, and most patients who screened positive received depression resources in discharge paperwork and psychiatric consultation.Keyword
Depressive Disorder, MajorDepression
Emergency Service, Hospital
Mental Health Services
Mass Screening
Identifier to cite or link to this item
http://hdl.handle.net/10713/22749Collections
The following license files are associated with this item: