Enhancing the Efficacy of Depression Screening within the Ambulatory Care Setting

Learning objective: Explain the systematic approach devised and change management required to conduct annual depression screenings in ambulatory care adult specialty clinics to address the growing mental health crisis and improve patient experience and outcomes in addition to exemplify this healthcare organization’s commitment to a comprehensive approach to healthcare and honoring our care mandates.
Purpose: Describe strategies used by a large 200-clinic ambulatory care site to successfully implement depression screening and discuss opportunities for best practices for system-wide change.
Background: Escalating suicide rates and limited mental health service access drive the critical need for depression screenings during healthcare touchpoints, including ambulatory care visits. A multidisciplinary team consisting of members from care transformation, quality improvement, nursing, operations, patient experience, analytics, Epic/IT, and behavioral health subject matter experts was created to devise a systematic approach for conducting universal annual depression screenings.
Methods: Utilizing the EHR, standardized screening tools were seamlessly integrated, allowing for automatic screening of adult patients with tailored educational materials based on their scores. Team members identify a patient’s risk for depression by administering the validated patient health questionnaire (PHQ)-2 screening tool. If the score is three or greater, the PHQ-9 screening tool is administered. Patient responses indicating self-harm intent generate a direct message for care teams to assess patient safety. Real-time safety assessments and collaboration with ambulatory care teams have been established through an internal behavioral health crisis line.
Findings: In April 2023, the annual depression screening was implemented in the specialty setting. By April 10, 2024, a total of 372,844 patients were screened, with 90,095 patients from specialty clinics. Of the patients screened, 0.9% reported severe depression and 1.8% expressed thoughts of suicide or self-harm. With real-time behavioral health support, two designated therapists received 700 calls regarding patients exhibiting signs of severe depression or suicide.
Conclusion: This underscores the effectiveness of collaboration and the screening tool in early identification and intervention. The approach, which combines screening, automation, and swift crisis intervention, has demonstrated significant efficacy in improving patient care and outcomes, addressing rising rates of suicide linked to untreated depression, and highlighting this organization’s commitment to holistic care.
Implications for nursing practice: By prioritizing depression screenings and integrating them into routine patient care, this model serves as a valuable blueprint for other healthcare organizations seeking to enhance mental health care delivery and mitigate the impact of untreated depression on individuals and the community.