Preferred Name
Lori Conyers
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Date of Graduation
12-16-2022
Document Type
Dissertation
Degree Name
Doctor of Nursing Practice (DNP)
Department
School of Nursing
Advisor(s)
Holly Buchanan
Monica Heck
Abstract
Identifying patients with depression is essential, and early detection of depression leads to early intervention. Routine screening of patients for depression is the responsibility of the primary care provider, but many patients have not had a primary care visit in the recent past. Those patients without a primary care provider are likely not being screened for depression. Urgent care (UC) may be the best opportunity to screen patients who do not have a medical home. However, the dynamic nature of the urgent care setting may dissuade staff from engaging in routine screening. As a quality improvement (QI) effort, regular PHQ screenings were incorporated into the rooming of patients in a UC, affiliated with a community hospital system. Positive screens triggered a referral to behavioral health for additional care. With the anticipated challenges faced, Implementation Science (IS) was utilized as a guide for overcoming the barriers.
Framing the project with Donabedian’s Model for health care QI, feasibility/acceptance surveys were collected pre-cycle to address the structure, and staff satisfaction surveys post-cycle were utilized to assess the process. Outcomes were assessed by collecting the numbers of those successfully screened at the UC during the trial.
From the Model for Improvement, two Plan, Do Study, Act (PDSA) cycles were performed to assess the success of the QI project. Training with UC personnel on the screening protocol occurred before implementation. The responses to the surveys guided the implementation process. Using the principles of IS, open communication with the UC team, leadership and stakeholders was maintained throughout the QI project. After the first PDSA cycle, the survey data was reviewed as well as feedback from the nurse manager, and before beginning cycle two, reminders were placed on computer monitors.
Results were measured by both anonymous surveys and by assessing the number of patients screened. Even with IS, the new screening process did not meet the Aims; however, progress was noted. Staffing shortages, as well as rising COVID-19 numbers, may have impacted the results. A self-completed electronic screening as part of the check-in process has been proposed, requiring additional studies.
Recommended Citation
Conyers, Lori, "Implementing routine depression screening in an urgent care setting: An implementation science project" (2022). Doctors of Nursing Practice (DNP) Final Projects, 2020-current. 21.
https://commons.lib.jmu.edu/dnp202029/21
