Abstract TP344: Adding Depression Screening at 90-Days Post-Stroke Increases the Number of Positive Screens

Abstract

Background: Comprehensive Stroke Centers are required by The Joint Commission to screen stroke patients with stroke for depression prior to discharge. Stroke related depression, however, may occur weeks or months after the acute event. Adding a 90-day screen may help identify additional patients with depression after discharge from the acute hospital setting. Purpose: To evaluate the impact of having a registered nurse (RN) perform 90-day post-discharge depression screening by telephone for patients with recent stroke. Methods: A team of RNs were trained on the Patient Health Questionnaires (PHQ2 and PHQ9). Both tools have been validated for telephone use. All ischemic and hemorrhagic stroke patients discharged home were included. Patients were called 90 days +/- 15 days post-discharge. Patients scoring positive on the PHQ2 (a score of > or equal to 3) were further evaluated by the RN using the PHQ9. Nurses referred patients scoring > or equal to 9 on the PHQ9 to the Stroke Medical Director for further evaluation. See graphic below. Results: Between August 2017 and July 2018, 297 patients were screened (56% of total stroke discharges, 297/527), of whom 8.8% (26/297) scored > or equal to 3 on the PHQ2. Of these, 73% had a PHQ9 score > or equal to 9 (19/26). All patients with a positive PHQ9 screen (19/19) were referred to the Stroke Medical Director and received appropriate triage and referral for ongoing care. This yielded a 6.4% rate (19/297) of stroke patients with symptoms of depression 90-days post-discharge. While some patients had a history of depression, most had no history or risk factors for depression. Conclusion: Conducting RN-facilitated 90-day post-hospital discharge telephone depression screening in patients with recent stroke appears to be an effective method to identify additional patients with stroke related depression who would not have been identified otherwise.