Peer-reviewed article
Increasing Rates of Health-related Social Needs Screening in a Pediatric Critical Care Setting Through Quality Improvement.
Muleta H, Pardo C, Klafter A, Velasco S, Whiskey-LaLanne R et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study describes a quality improvement project in a pediatric intensive care unit (PICU) that aimed to increase screening for health-related social needs (HRSNs)—such as food insecurity, housing instability, and other social determinants of health—among critically ill children. Using multidisciplinary team collaboration and systematic quality improvement cycles, the program increased HRSN screening rates from 18% to 76.5% over a 16-month period. Among screened patients, 28% reported at least one unmet social need, and the program achieved a 64% referral rate to community health workers who help connect families with resources.
Key points
- HRSN screening completion increased from 17.9% baseline to 76.5% by end of intervention period
- Among screened patients, 27.7% reported one or more unmet health-related social needs
- Mean community health worker referral rate was 64% among those with unmet needs
- Six interventions were implemented across multiple quality improvement cycles to optimize screening workflow
- Study included 1,256 direct admits to the PICU over the intervention period
Limitations
The study does not report longer-term outcomes or whether families actually engaged with community health worker services and resources. The design does not include a comparison group, so we cannot determine whether the screening increases alone improved health outcomes for children.
Abstract
Introduction Prior research has linked health-related social needs (HRSNs) with poor pediatric health outcomes. Studies have demonstrated the implementation of HRSN screening in lower-acuity settings, but few have been conducted in pediatric intensive care units (PICUs). Our primary aim was to increase HRSN screening from 4% to 75% between February 2024 and May 2025. Our secondary aim was to increase referral rates for community health workers (CHW) from 0% to 75% for those with unmet HRSNs. Methods A multidisciplinary team used quality improvement (QI) methodology to implement interventions in a 26-bed PICU at an urban, tertiary-care children's hospital. The study included all patients admitted to the PICU. We implemented six interventions over multiple plan-do-study-act cycles to optimize screening and CHW resource navigation workflow. Results Data collection included sociodemographic characteristics and monthly HRSN screening completion, positive screens, and CHW referral rates. During our intervention period, there were 1,256 direct admits to the PICU. By the end of the study period, an average of 76% of patients had a completed HRSN screen, just over our anticipated goal. The mean HRSN screening increased from a baseline of 17.9% to 76.5. Among screened patients, 27.7% reported ≥1 unmet HRSN, with a mean CHW referral rate of 64%. Conclusions A multidisciplinary team approach and use of QI methodology led to an increase in monthly HRSN screenings in our PICU. Next steps will focus on increasing CHW referral rates and connecting patients with resources for unmet HRSNs.