Abstract

Despite the increased awareness of social determinants of health (SDoH), integrating social needs screening into health care practice has not consistently occurred. No social needs screening using recommended standardized questions was available at an outpatient hemodialysis clinic. Plan-Do-Study-Act cycles, based on the Model for Improvement, were used to implement the Core 5 SDoH screening tool, a staff referral process, and an evaluation of the implementation process. A standardized social needs screening tool and a staff referral process were implemented. An evaluation of the implementation process also occurred. Of 73 patients screened, 21 reported 32 unmet social needs; all received referrals to community resources. Nurses demonstrated high acceptance and usability of the tool and the referral process. Implementing a standardized screening and referral process customized to clinical workflow enhanced the identification of social needs in patients undergoing hemodialysis.

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