HEADSS Up! Missed Opportunity for Psychosocial Screening in Hospitalized Adolescents

Abstract

OBJECTIVE: To assess the frequency and completeness of adolescent psychosocial screening documentation for adolescents and young adults hospitalized to a pediatric hospitalist medicine service. METHODS: All patients 12 to 21 years old on the hospital medicine service in an urban, academic, free standing children’s hospital in the Mid-Atlantic United States from January 1, 2014, to December 31, 2015, were identified. A retrospective review was conducted to assess the frequency of documentation of a complete psychosocial screening using the Home, Education, Activities, Drugs, Sex, Suicide assessment within 48 hours of admission. Differences in screening rates according to race, sex, age, patient’s medical complexity, and whether they required transfer to a higher level of care were assessed through logistic regression analyses. RESULTS: Only 5.3% (24 of 435 patients) had all 6 domains of the Home, Education, Activities, Drugs, Sex, Suicide psychosocial assessment documented. Controlling for patient characteristics (demographic, medical complexity, and level of care), the odds of being screened for sensitive domains (drugs, sex, and suicide) were higher in female patients, patients ≥16 years old, and those transferred to a higher level of care. Those considered high medical complexity were screened less across all domains. CONCLUSIONS: Overall, pediatric hospitalist documentation lacked adolescent psychosocial screening. Potential opportunities exist through screening early in the hospitalization to connect youth with services that influence health outcomes.