Standardizing Depression Screenings in Step-Down Patients with Heart Failure

摘要

Patients with heart failure (HF) have an increased prevalence of depression. In addition, the two comorbid conditions can worsen each other leading to additional complications. While a validated depression screening tool exists, the PHQ-9, literature shows that it is being underused and depression is under-assessed in patients with HF. To improve depression screening rates, a standardized depression screening process was adopted in this quality improvement (QI) project. This was performed by the advanced practice providers (APPs) on a heart failure service and guided by the Iowa Model of evidence-based practice. A PHQ-2/9 depression screening tool was added to the history and physical exam (H&P) note in the electronic health record (EHR) completed when a new patient is admitted to the service. An evidence-based education session with a pre- and post-survey was given to the APPs to increase awareness of comorbid HF and depression and review treatment methods. Results showed an increase in screening rates from 0% to 37.93% and an increase in APP knowledge, awareness, and comfort with HF and depression. One person screened positive for depression during the intervention; however, this patient was not given additional treatment for depressive symptoms. This QI project successfully increased depression screenings for patients with HF, and the structured education session increased provider awareness of depression and HF.