131 - Quality Improvement Initiative: Implementation of a Standardized NICU-Specific Social Determinants of Health Screener

Publication Number: 3125.131

Christina E. Lewis, The Mount Sinai Kravis Children's Hospital, New York City, NY, United States; Richelle M.. Reinhart, The Mount Sinai Kravis Children's Hospital, New York, NY, United States; Melody Eaton, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Carla Somnolet, The Mount Sinai Hospital, New York, NY, United States; Matthew J. Drago, Icahn School of Medicine at Mount Sinai, CLINTON, CT, United States; Toni Stern, Icahn School of Medicine, New York, NY, United States; Katherine Guttmann, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Background: Addressing Social Determinants of Health (SDoH) is critical to improving outcomes for the uniquely complex and vulnerable Neonatal Intensive Care Unit (NICU) patient population. However, routine, standardized SDoH screeners specific to the NICU population are lacking.

Objective: Global aim: To improve care for NICU patients and their families by addressing SDoH.

Specific aim: To increase the number of NICU families screened for SDoH from zero to greater than 50% from Fall 2024 to Fall 2025.

Design/Methods: Our team utilized the Model for Improvement to implement a previously published SDoH screener adapted for our Level IV NICU. Key Drivers included: lack of a standardized screening approach, need for NICU-specific questions, need for a resource guide, and equitable screening regardless of primary language (Figure 1). Interventions included: adding NICU-specific questions (breastfeeding/breastmilk provision, family leave, prenatal care, and infant preparedness), identifying a Social Work champion and leadership involvement, weekly NICU Attending check-ins, and screener integration into the electronic medical record (EMR). Outcome measures included: percent of 1) NICU families screened, 2) families screened by primary language. Process measures included: percent of 1) SDoH screeners documented within one business day of admission, 2) families reporting at least one unmet need. To ensure the use of the EMR did not impact timely documentation, a balancing measure of the number of days between NICU admission and documentation of SDoH was used.

Results: After interventions, SDoH screening increased from 0% to 41% (Figure 2). Changes in baseline were observed following introduction of the NICU-specific SDoH screener and conversion to EMR-based screening. With introduction of EMR-based screening, families reporting at least one unmet need fell from 91% to 27% (Figure 3). Unmet needs were driven largely by need for transportation assistance. In the EMR, modification of the transport question underestimated families' needs. Families with primary language other than English were screened more than English-speaking families. EMR-based screening increased the time to documentation.

Conclusion(s): A standardized, NICU-specific SDoH screener was implemented in our Level IV NICU. Screening rates, though below the target of 50%, continue to improve. The most impactful intervention was introduction of an EMR-based SDoH screener, though it increased completion time. In upcoming PDSA cycles, priorities include adjustment of screening questions, resource guide distribution, and improving team awareness of families' needs.

Figure 1. Key Driver Diagram
Key Driver Diagram highlighting key drivers and interventions to standardize SDoH screening in our Level IV NICU.

Figure 2. Percent of Families Screened per Month Control Chart.
Control chart showing baseline SDoH screening data and post-intervention data with key interventions outlined.

Figure 3. Percent of Families Reporting One or More Unmet Needs Control Chart
Control chart showing baseline unmet needs data and post-intervention data with key interventions outlined.