Becker's Clinical Quality & Infection Control

12 I n the past, acute care and mental health care have been siloed. It's only recently that healthcare systems have come to the conclusion the two have more in common than was previously thought. The mind and the body are not separate entities, where health outcomes are concerned. Now, with the advent of extreme pressure to streamline care across the con- tinuum, it's clear that a focus on mental health care has great potential to im- prove acute-care outcomes. Mental health issues are part of a broader spec- trum of health concerns that can make medical treatments, including those under the umbrella of acute care, less effective. Patients with undiagnosed or untreated mental health issues are more likely to neglect their care, end up in the wrong care stream, require a hospital readmission or simply avoid the hospital all together. Cedars Sinai Health System in Los Angeles has tackled these challenges head- on: It has introduced a system-wide collaboration between its psychiatry and nursing departments that screens every adult medical patient for symptoms of depression. According to the system, the initiative is one of the broadest hospital depression screens in the United States. From an epidemiological perspective, depression is arguably the most sig- nificant mental health issue. A substantial proportion of the global disease burden is due to depression; it has a greater impact worldwide on human health than any other medical condition and is the leading cause of disability worldwide. In the United States, the condition affects at least nine percent of the population, according to the Centers for Disease Control and Prevention. In U.S. healthcare, between 10 percent and 30 percent of patients with an- other illness also have depression. The condition exacerbates symptoms, the course of an illness, outcomes, satisfaction and adherence to care. The U.S. Preventative Services Task Force has recommended depression screening as a best practice, provided treatment resources are available. However, this best practice is not yet widely followed, according to Itai Danovitch, MD, MBA, chair of the Cedars-Sinai department of psychiatry and one of the champi- ons of the health system's initiative. Cedars-Sinai nurses are the frontline representation of the initiative. They use the two-question Patient Health Questionnaire-2 to ascertain whether the patient has felt depressed in the past two weeks. If a patient screens posi- tive, he or she takes the PHQ-9, which further explores the potential risks and may trigger an alert for the patient's physician and social worker, if the patient is at a high enough risk for depression. Through the screen, Cedars-Sinai hopes to improve targeted treatments for individuals, helping them improve from other illnesses without having to battle underlying depression in tandem. "In patients with medical problems, if their depression goes untreated, they have worse outcomes," says Dr. Da- novitch. "This initiative recognizes that depression is incredibly common in medical populations. It improves our ability to proactively identify patients with depression. When we recognize them, we can educate them, and offer appropriate treatments or referrals." One challenge: Identifying a patient with clinical depression doesn't guaran- tee he or she will get treatment. While nurses and physicians can recommend treatments and refer patients to specialists, there are many barriers to care, such as stigma, adequate insurance coverage and accessibility of specialty care. As a first step, Cedars-Sinai is establishing system-wide awareness and de- veloping partnerships with providers who can provide high-quality mental health care. Dr. Danovitch describes the initiative's current goal as an infor- mation blitz. Stakeholders are presenting the initiative at committee meet- ings, putting it on screen savers, making an educational push and getting the word out to as many people as possible. While it's still early in the process, Dr. Danovitch says there has been plenty of support: "The important thing is that across the board our healthcare pro- viders have been receptive to the initiative, which is allowing us to provide more holistic healthcare." The initiative is an integral part of Cedars-Sinai's response to healthcare reform, according to Dr. Danovitch: "One of the things healthcare reform has taught us to recognize is that if we want to improve health outcomes, we have to focus on addressing underlying behavioral health issues. It is imperative we make efforts to identify mental health and substance abuse problems," he says. n Improving Health Outcomes at Cedars-Sinai Depression screening brings mental health integration into acute care, with promising results By Ellie Rizzo Experts Update CAUTI Prevention & Treatment Guidelines By Ellie Rizzo The Society for Healthcare Epidemiology in America, Infectious Dis- eases Society of America, American Hospital Association, Association for Professionals in Infection Control and The Joint Commission have published the first updates since 2008 in a series of guidelines for pre- vention and management of catheter-associated urinary tract infec- tions in Infection Control and Hospital Epidemiology. The seven-article compendium will be rolled out over several months and will detail the newest evidence-based strategies for preventing CAUTIs, including guidance on catheter use, overuse and misuse. The updated guidelines urge catheter use only when strictly medically necessary and also provide guidance for acute-care facilities on cath- eter insertion and management, education of healthcare personnel and surveillance of in-use catheters. Future articles will include strategies to prevent Clostridium difficile, surgical site infections, methicillin-resistant Staphylococcus aureus, central-line associated bloodstream infections, ventilator-associated pneumonia and will feature an article on best practices for hand hy- giene improvement, according to a report from News Medical.net. n

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