IMPLEMENTING DEPRESSION SCREENING AND TREATMENT ALGORITHMS TO REDUCE POST-OPERATIVE COMPLICATIONS FOR PATIENTS UNDERGOING CARDIAC SURGERY

ABSTRACTSavannah Pruden: Implementing Depression Screening and Treatment Algorithms to Reduce Post-Operative Complications for Patients Undergoing Cardiac Surgery(Under the direction of Carrie Palmer)Background: In patients with cardiovascular disease, depression is common and linked to highermortality rates, poorer prognosis, increased healthcare costs, and lower quality of life. Under 20% ofpatients with cardiovascular disease are adequately treated for depressive symptoms. However, depressionscreening is not routine or systematically implemented in outpatient cardiac surgical settings.Objective: This quality improvement project aimed to create a routine, sustainable process for anoutpatient cardiac surgical clinic in Raleigh, NC. Goals included screening adults following cardiacsurgery for depression, assessing patients with elevated depression screening scores, and performing anintervention using an evidence-based treatment algorithm.Methods: During a 12-week implementation period, staff members administered a Patient HealthQuestionnaire tool to patients at their two-week assessment post-cardiac surgery. Scores were documentedand reviewed by a nurse practitioner. If the depression score was elevated, the nurse practitioner assessedand implemented a treatment plan. Compliance was measured by the number of patients screened, andimpact was measured by the number of patients who had elevated screening scores with a documentedtreatment plan. A qualitatively-analyzed staff survey measured sustainability and responsiveness.Results: The nurse practitioner encountered 242 patients; 50% were eligible for screening. Of those(n=121), 100% screening was performed. Out of the 121 patients, questionnaires yielded 25 patients withelevated depression screening scores. The nurse practitioner informed patients’ primary care provider(n=22, 88%), initiated educational resources (n=7, 28%), provided medication administration (n=1, 4%),made a referral to a primary care provider (n=3, 12%), and made a referral to a psychotherapist (n=5,iii20%). For clinic impact, 60% of staff members reported that the screening process lengthened check-intimes and added cumbersome paperwork; 40% reported no negative impact on clinic flow; and 80%reported that screening added value to the clinic and patient population.Conclusions: This project validated the need to assess depression within this population. It alsodemonstrated how a depression screening tool can be implemented in an outpatient cardiac surgical clinicand how office providers can execute an evidence-based treatment algorithm. Furthermore, these resultscontribute to a growing body of literature and can impact efforts of future studies.