Improving psychosocial distress screening in a palliative care outpatient clinic: A quality improvement project

ABSTRACT Background: Psychosocial care is a key component of palliative care. Proactive identification of psychosocial needs and distress can guide appropriate patient-centered care. Objectives: The primary objective was to increase psychosocial assessments of palliative care outpatients at their first and review visits by 10% and 20%, respectively, from baseline values of 68% and 11%, between April and September 2021, through a quality improvement (QI) project. The secondary objective was to assess the sustainability of these improvements over a one-year period. Materials and Methods: Using A3 methodology, key contributors were identified by process mapping, fishbone analysis, and Pareto charting. Key drivers and interventions were developed through team discussions. Interventions included implementing screening checklist to prioritize outpatients at risk for psychosocial distress, rescheduling psychosocial assessments, streamlining medical record flow, using distress thermometer scores for follow-up, restructuring psychologist’s work schedule, and designating a specific consultation space. Reliability and sustainability of interventions were supported through delegation of ownership to specific team members. Results: The target 10% increase in psychosocial assessments for first visits was not achieved; however, the 20% increase for review visits was achieved. Among 75.8% of outpatients (760/1003) who screened positive for being at risk for distress, 73.4% (558/760) received psychosocial assessment and support. One-year follow-up demonstrated that improvements were not sustained. Conclusion: While psychosocial assessments increased for review visits, achieving similar improvement for first visits remained challenging. Nevertheless, the interventions enhanced psychosocial support for palliative care outpatients. Improving reliability, reassessing root causes, and conducting reaudits are possible steps to guide further improvement.