Hosp Pediatr. 2023 Jul 1;13(7):588-596. doi: 10.1542/hpeds.2022-006955.
Hospitalizations are opportunities to screen adolescents for risk behaviors, but screening occurs infrequently. At our institution, adolescent inpatients on pediatric services have an array of medical acuity and complexity, and only 11% had complete home; education; activities; drug, alcohol, and tobacco use; sexual history; and self-harm, suicidality, and mood (HEADSS) histories. The aim of this quality improvement project was to increase the HEADSS completion rate to 31% within 8 months of the initial Plan-Do-Study-Act cycle.
A working group identified key drivers of incomplete HEADSS histories. Interventions focused on creating and modifying note templates to encourage providers to obtain and document HEADSS histories, sharing data with providers, and educating providers. The primary outcome measure was the percent of patients with a complete HEADSS history. Process measures included use of a confidential note, documentation of a sexual history, and number of domains documented. The balancing measure was patients with no social history documented.
A total of 539 admissions were included, 212 in the baseline period and 327 in the intervention period. The percent of patients with a complete HEADSS history increased from 11% to 39%. Use of a confidential note increased from 14% to 38%, documentation of a sexual history increased from 18% to 44%, and average number of domains documented increased from 2.2 to 3.3. The number of patients with no social history documented was unchanged.
A quality improvement initiative using note templates can significantly increase the rate of complete HEADSS history documentation in the inpatient setting.
住院是筛查青少年风险行为的机会，但这种筛查很少进行。在我们的机构中，儿科住院患者的医疗严重程度和复杂性各不相同，只有 11%的患者完成了家庭、教育、活动、药物、酒精和烟草使用、性史以及自我伤害、自杀意念和情绪（HEADSS）的病史记录。本质量改进项目的目的是在最初的计划-执行-研究-行动循环的 8 个月内将 HEADSS 完成率提高到 31%。
一个工作组确定了导致 HEADSS 病史不完整的关键驱动因素。干预措施侧重于创建和修改医嘱模板，以鼓励提供者获取和记录 HEADSS 病史，与提供者共享数据，并对提供者进行教育。主要结果测量指标是完整 HEADSS 病史患者的百分比。过程测量指标包括使用保密医嘱、记录性病史和记录的域数。平衡措施是记录没有社会病史的患者。
共纳入 539 例住院患者，其中基线期 212 例，干预期 327 例。完整 HEADSS 病史患者的比例从 11%增加到 39%。使用保密医嘱的比例从 14%增加到 38%，记录性病史的比例从 18%增加到 44%，记录的平均域数从 2.2 增加到 3.3。没有社会病史记录的患者数量没有变化。
使用医嘱模板的质量改进举措可以显著提高住院患者完整 HEADSS 病史记录的比率。
