Redesigning Inpatient Postpartum Care to Achieve Universal Depression Screening and Early Connection to Behavioral Health Support.

OBJECTIVE

The objective of this study is to evaluate whether a nursing-led postdelivery inpatient workflow increased universal perinatal depression screening and improved referrals to behavioral health services. A secondary objective was to evaluate implementation process using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.

STUDY

DESIGN

This retrospective cohort study included all postpartum patients delivering at an urban academic hospital from February through June 2024. We developed a standardized workflow with nursing leadership and reproductive psychiatry, training nurses to administer the Edinburgh Postnatal Depression Scale (EPDS), to all postpartum patients on postpartum day 0. Scores ≥ 10 prompted nurses to place a social work consult and request the obstetric provider to place a reproductive psychiatry consult. Reach and effectiveness were evaluated using a pre-post study with social work referrals as the primary outcome. Secondary outcomes included EPDS completion rate, screen-positive rate, and psychiatry referrals. Logistic regression was used for adjusted analyses. Adoption was assessed through provider workflow adherence, and implementation was assessed through semistructured patient interviews and nursing surveys.

RESULTS

Among 522 postpartum patients (260 preintervention and 262 postintervention), screening completion increased from 25.7 to 95.0% (67/260 vs. 249/262, p < 0.001). Positive screens rose from 1.5 to 6.8% (1/67 vs. 17/249, p < 0.001). Social work referrals rose from 34.6 to 47.7% (90/260 vs. 125/262, p = 0.002). In an adjusted analysis, the intervention remained associated with higher odds of social work referral (adjusted odds ratio: 1.56; 95% confidence interval: 1.02-2.41, p = 0.04). Reproductive psychiatry referrals increased but were not statistically significant. Most nurses reported comfort with the workflow, and patients indicated screening was acceptable and helpful.

CONCLUSION

A simple and scalable nursing-led workflow achieved near-universal inpatient perinatal depression screening, improved identification of depressive symptoms, and increased behavioral health referrals. This workflow is feasible, acceptable to nurses and patients, and offers a replicable framework for hospitals seeking to integrate inpatient perinatal depression screening into standard practice.

KEY POINTS: · A simple nursing-led workflow integrates perinatal depression screening into routine inpatient care.. · Universal inpatient postpartum screening increased symptom detection and social work referrals.. · Patients and nurses found the workflow acceptable and easy to integrate into standard care..