P1.250: Quality Improvement Initiative to Increase Primary Caregiver SDOH Screening in a Level III Community Hospital NICU

Purpose/Objectives: In 2024, we began a quality improvement (QI) initiative to increase screening for social determinants of health (SDOH) among primary caregivers (PC) of infants admitted to our Level III NICU. Despite being located in a medically underserved community, routine SDOH screening during admission was not an established practice in our NICU. We relied on screenings conducted in Labor and Delivery; however, these were often inconsistent or inaccessible to the NICU care team. Recognizing these barriers, we implemented a QI initiative with the S.M.A.R.T AIM.: Within six months, we will increase the percentage of PC screened for SDOH in the NICU by 20% from baseline.

Design/Methods: An interdisciplinary team of physicians, nurse practitioners and nurses developed a Driver Diagram (Figure 1). A family of measures was established, including the process measure (percentage of PC screened for SDOH) and outcome measures (percentage of SDOH-positive PC referred to resources and overall percentage of PC referred to community services).
Major interventions focused on education, workflow integration, and accessibility. Providers received educational sessions on the importance of SDOH screening. To increase accessibility, screening forms were kept at the bedside, and completion was verified during rounds. The screening tool was refined to focus on five domains: housing, food insecurity, utilities, safety, and transportation. Additionally, a section was added to assess the need for infant care supplies after discharge. To address language barriers, the screen was translated into Haitian-Creole, Spanish, and Brazilian Portuguese—the predominant non-English languages in our NICU. We also partnered with our local Healthy Start Coalition to ensure that families screening positive were connected with appropriate resources. Interventions were tested through Plan-Do-Study-Act (PDSA) cycles.

Results: 87 PC SDOH screens were completed between January and December of 2024. The average percentage of PC screened increased from 71% to 100% during this period (Figure 2). Overall, 33% of PC had positive SDOH screens. Food insecurity was the most commonly reported need (36%), followed by housing, utilities, and transportation (18% each), and safety (14%). Additionally, 18% of caregivers expressed a need for infant care supplies post-discharge. All PC with positive SDOH screen results were given a referral for community resources. Overall, referral rates for community services increased from 83% to 100%.

Conclusion/Discussion: The AAP recommends SDOH screening of PC in the NICU. In 2024, we made this standard in our Level III NICU, located in a medically underserved community. Screening rates rose to 100% after staff education, workflow integration, and screen translation. We also formed a key partnership with Healthy Start, which helped families with positive screens and contributed to a 100% referral rate. As the initiative continues, we now screen multiple times during the NICU stay to address evolving needs.