Screening for Social Needs in Critically Ill Patients: Addressing More than Health Conditions

From the 2021 HVPAA National Conference

Danielle Maholtz (Cincinnati Children’s Hospital Medical Center), Carley Riley

Background

The County Health Rankings estimates medical care accounts for only 10-20% of modifiable health factors. The remaining factors are attributed to various health disparities. Eliminating inequities in health outcomes requires innovation in how children with unmet social needs are identified. The National Academies of Sciences, Engineering, and Medicine (NAESM) proposed a framework to integrate patients’ social needs with health care delivery. This framework begins with increasing awareness of social risk. Screening tools have been validated for identification of unmet social needs in pediatric outpatient offices. Recognition that patients with unmet social needs frequently have difficulties with outpatient follow up has led to efforts to screen in the acute care and inpatient settings. Children requiring critical care have been recognized as being at greater risk for unmet social needs than the general population, but no study has yet utilized screening to identify unmet social needs in the pediatric critical care patient population.

Objective

We seek to develop and optimize a standardized tool and process for screening critically ill patients and their caregivers for unmet social needs at Cincinnati Children’s Hospital Medical Center (CCHMC). Using this process, we aim to increase the percentage of Pediatric Intensive Care Unit (PICU) patients who reside in Hamilton County who are screened for unmet social needs from 0 to 80% by June 31, 2021.

Methods

We applied improvement science to develop and evaluate a social needs screening process, employing patient and staff feedback to inform frequent assessment and process changes. Our screening tool was developed using previously published social needs questionnaires to address all social determinant of health domains. Our course was guided by the experience of a multidisciplinary team including attending physicians, trainees, bedside nurses, advanced practice practitioners and social workers. This approach allowed for the collaborative development of a process to identify unmet social needs in our patients. We limited testing to patients who lived in Hamilton County as we developed the new screening process.

Results

Of 74 patients/caregivers who qualified for screening during the initial 5 months of testing, 37 completed screening (50%). Eleven declined participation, with 26 missed due to language barriers, technical issues, clinical status, and caregiver availability. Of those who completed screening, 53% were positive for at least one social need. Nine requested assistance (56%) and 89% reported urgent needs. Three of the patients/caregivers felt uncomfortable being asked social needs questions (10%), specifically when asked demographically about their household income. Twenty-one appreciated being asked about social risk during their PICU admission (70%).

Conclusions

Critically ill patients are at increased risk of health disparities presence on admission. Patient acuity is not a limiting factor for identifying these social needs. Critically ill patients and their caregivers appreciate being asked social needs questions and receiving assistance. Additionally, a standardized approach to screening for unmet social needs in a critical care environment can reduce staff concerns for increased workload and topic discomfort.

Clinical Implications

Previous studies have identified increased hardship of hospitalization on those with social risk prior to admission. Collecting individualized data on social needs in critically ill patients will inform and support a response to health disparities in a high risk population. Aggregate data may inform future studies examining the composition of social needs in critically ill patients to highlight systematic changes to improve population health.