Screening for Secondhand Smoke Exposure in Pediatric Patients Ages 0-8 at the UPMC Shadyside Family Health Center
Ellen Saridakis, DO; Scott Brown, DO; Alissa Cohen, DO, MS; Lori Stiefel, MD; Jacqueline Weaver-Agostoni, DO, MPH
Background:
The American Academy of Pediatrics recommends secondhand smoke (SHS) exposure screening at all pediatric encounters, due to associated increases in risk for infections, asthma exacerbations and school absences. The Shadyside Family Health Center (SFHC) had no standardized SHS screening process therefore a screening tool was introduced.
Methods:
Baseline SHS screening rates were assessed by chart review of well-child visits in ages 0-8 years, between February and August 2018, including the existing Interconception Care (ICC) maternal smoking history for ages <3 years. The existing maternal smoking screening tool was expanded to include other adult smoking contacts. An electronic SHS screening documentation template was developed but requires initiation by the physician. SFHC providers received two 15-minute didactic SHS education sessions and reminders during office huddles. A second chart review assessed post-intervention SHS screening rates and inclusion of “SHS exposure” in problem lists of patients with positive screens. Outcomes are reported using descriptive statistics..
Results:
The pre-intervention SHS exposure screening rate at well-child visits in ages 0-8 years was 44.3% (155/350 visits), with ICC screening accounting for 96.7% of these visits (150/155). The post-intervention screening rate for ages 3-8 years improved from 4.9% to 30.6% (45/147) and among those <3 years screening improved from 71.2% to 76.6% (144/188). The overall post-intervention screening rate was 56.4% (189/335). Of 41 patients screening positive, 23 patients had “SHS exposure” added to their problem list, an increase from 0% to 56.1%.
Conclusion:
A standardized screening process for SHS exposure for pediatric patients was successfully implemented at the SFHC with screening rates increasing, primarily among patients ages 3-8 years. Further quality improvement cycles should focus on automatic integration of SHS screening into existing well-child visit documentation, as well as translating increased screening into interventions to reduce the amount of SHS exposure in