P2D126: Implementing Depression Screening for Adolescent Patients in a Pediatric Inpatient Setting: A Quality Improvement Project

Purpose/Objectives: Major depressive disorder (MDD) is the most common mental health disorder in adolescents. The prevalence of MDD has increased significantly since the COVID-19 pandemic. Although adolescent depression screening is strongly recommended by the AAP, there are very few published cases of pediatric patients being screened in the inpatient setting. Implementation of depression screening using QI methodology can increase identification of adolescents at risk for depression and suicide. Our Smart Aim was to increase the rate of depression screening in adolescent patients admitted to the pediatric hospitalist service from 0% to 70% within 6 months. Our process measure was the rate of depression screening; our outcome measure was the documentation that appropriate interventions were provided; and our balancing measure was the length of stay for hospitalized patients.

Design/Methods: Patients met criteria if they were 12 to 18 years old and admitted by the pediatric hospitalist service. Eligible patients were screened using the Patient Health Questionnaire 2 (PHQ-2). If the score was less than 3, then no further intervention was required. If the score was 3 or higher, then patients received the interventions as outlined in Figure 1. Multiple PDSA cycles were performed, which included education for residents and hospital medicine nurse practitioners/attendings on importance of screening, addition of screening tools and proposed interventions to the EMR, and provision of resources for mental health follow up. Rates of depression screening, positive screens, provision of interventions, and length of stay were analyzed.

Results: Three months after project implementation, screening rates increased from 0% to 49%. Of 201 eligible patients, 49% (N=99) were screened with the PHQ-2, and 7% (N=7) met criteria for PHQ-9 screening. Of patients screened with the PHQ-9, 43% (N=3) scored 3-9, 57% (N=4) scored ≥10, and 86% (N=6) received the appropriate intervention based on scores. Interventions included the provision of mental health resources, psychology consultation, and inpatient psychiatry consultation. One patient was found to have active suicidal ideation and required admission to inpatient psychiatry. All 7 patients had non-mental health related admission diagnoses, and 71% (N=5) had no prior history of MDD. There was no overall increase in length of stay for patients with positive PHQ-2 screens.

Conclusion/Discussion: Our QI project successfully identified hospitalized adolescents at high risk for MDD who likely would not have been otherwise identified. Nearly all patients who screened positive received appropriate interventions. Referral to mental health providers can reduce morbidity and mortality amongst adolescents with depression. Patients with non-mental health related admissions are still at risk for MDD and suicide; therefore, implementation of depression screening in hospitalized adolescents is imperative for the future of pediatric hospital medicine.