Background:

Approximately 20% of hospitalized patients are rehospitalized within 30 days of discharge. The presence of depression, anxiety, and substance abuse in a hospitalized patient increases the patient’s risk for rehospitalization. By identifying and treating these risk factors in hospitalized patients, we may be able to reduce unnecessary rehospitalizations.

Purpose:

We aim to use an existing nurse–driven process to (1) screen all hospitalized patients for depression, anxiety, substance abuse, and suicidality; and (2) link the results of the screen with specific interventions designed to reduce the impact of these factors.

Description:

We bundled standardized, validated, brief screening tools for depression (PHQ–2), anxiety (GAD–2), substance abuse (SASQ, SDUSQ), and suicide (PHQ–9 Q9) into one easy–to–use tool: the DAPS screen. The depression, anxiety, polysubstance abuse and suicide (DAPS) tool may be completed by the patient directly or administered to the patient by the nurse or physician. We used existing nursing processes to trigger a DAPS screen performed by clinical social workers. To start, the RN completes an existing mental health screen during the admission assessment. If the mental health screen is positive, the RN consults a Social Worker. The Social Worker completes the DAPS screen and then triggers interventions to reduced psychiatric risk factors for reshospitalization identified by the DAPS.

Conclusions:

Over a 9–month period, 34 hospitalized patients received the DAPS screen; 20 of those 34 patients screened positive. The process resulted in 45 interventions triggered for patients with positive DAPS screens (Table 1; Figure 1). Patients with positive DAPS screens were more likely to be rehospitalized within 30 days due to general medical conditions (Table 2; Figure 2). Furthermore, 45% of patients with a positive DAPS screen were either rehospitalized or visited the ED within 30 days of discharge. Only four interventions were triggered for patients with negative DAPS screens, indicating appropriate use of behavioral health care resources. The success and ease of use of the DAPS tool has resulted in a push to incorporate the DAPS tool into the nursing admission database. With this change, all patients admitted to Henry Ford West Bloomfield Hospital will be screened for depression, anxiety, substance abuse and suicidality. In addition, we are redesigning the work flow of the nursing and social work staff to allow for a focused behavioral health evaluation based on results of the DAPS screen.

Table 1Not All Positive DAPS Screens Require Inpatient Intervention

Table 2Positive DAPS Screen Reflects Increased Risk of Rehospitalization

Figure 1Interventions triggered by DAPS screen

Figure 2DAPS screens and rehospitalizations by month.

« Back to Hospital Medicine 2012, April 1-4, San Diego, Calif.