Implementing a Process for Screening Hospitalized Adults for Food Insecurity at a Tertiary Care Center

Abstract

Food insecurity has been linked to numerous chronic conditions and higher healthcare costs; however, screening for food insecurity lags behind screening for other social determinants of health, particularly in the hospital setting. Although our hospital serves a population with a high prevalence of food insecurity, no process previously existed to universally screen patients. Our multidisciplinary team developed and implemented a process to screen hospitalized adults for food insecurity and connect them with food resources, which we piloted on a 26-bed hospital medicine unit. We integrated a validated 2-item screen into the electronic health record (EHR) nursing admission workflow, and provided 2 weeks of nursing education before process implementation. Adherence to screening was monitored weekly and adjustments were made using plan-do-study-act cycles. After 28 weeks, 361/587 (61.5%; weekly average 61.1%) encounters were screened (compared with a baseline of 2.2%), with 21/361 (5.8%) identified as food insecure. The implementation of an EHR-based food insecurity screening process in the hospital setting increased screening and identification of food insecure patients. Through improved integration of screening questions into the existing nursing workflow and continued education, success was sustained despite challenges with nursing staff turnover and staff shortages during the COVID-19 pandemic.

Food Insecurity Screening in High-Income Countries, Tool Validity, and Implementation: A Scoping Review

“…Eight papers presented findings from quality improvement projects and interventions that aimed to increase screening rates [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. The remaining 29 papers described the experiences of undertaking screening or being screened.…”

“…While it was generally seen as advantageous to have one person assigned to carry out the initial screening, there were also benefits to having multiple staff/clinicians engaged in the process. "It's helpful to have multiple people who are responsible for asking this because it establishes that as a culture that this is an important part of healthcare" [75] (p. 3) How screening occurred was linked to privacy and efficiency, with integration into electronic medical records described as the most consistent and efficient [43,58,62,63,72,78,79]. Several papers indicated that patients were more likely to disclose FI if the screen was self-administered [44,58,65,80] or completed in writing [81] as the experience was perceived as non-threatening and with enhanced privacy.…”

Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions

“…Some studies [29,[32][33][34] developed their own questionnaires and screening sets, reflecting a trend towards customized tools tailored to specific healthcare settings or populations. Vendor-specific tools, like the two-item screening tool [35] integrated into Epic SDoH Wheel, were less common, but still present. The screened determinants varied, but commonly included factors included housing, food insecurity, transportation, and mental health indicators like stress and depression.…”

Moving Beyond Describing Disparities: The Urgent Need to Understand Multilevel Determinants and Evaluate Programs Promoting Health Equity

“…3 Another paper demonstrated that it is possible to screen in an inpatient setting for food insecurity. 4 This could further enhance the efforts of the interprofessional heart failure clinic to provide food for recently hospitalized patients. 3 The articles in this issue also provide reminders that it is important to consider the policy, organizational, and educational environments within which health systems operate.…”

“…3 Another paper demonstrated that it is possible to screen in an inpatient setting for food insecurity. 4 This could further enhance the efforts of the interprofessional heart failure clinic to provide food for recently hospitalized patients. 3…”