Too many screening questions?

[Emergent, RN]

I believe healthcare is attempting to solve too many problems by implementing multiple screening questions. Individually, these questions are well-meaning attempts to address real problems. But, The sum total of the increasing amount of screening questions decreases the efficacy of each one.

I understand the intentions of each one individually, but the sum total is overkill. It seems like each year adds a new one. Suicide prevention, fall prevention, tuberculosis screening, abuse and neglect screening, tobacco, drug abuse, sexual carelessness. The more things that are added, the less efficacious the process becomes.

I don't know what the solution is, but adding new screenings is not helping our patient population in my opinion.

[HeySis, BSN, RN]

I agree that all these screenings have a purpose... in the right environment. It is unlikely that they are all pertinent at every visit. But my biggest issue is the screening is done and then.... wait for it... nothing. Thats' right, nothing comes from most of these screenings.

For what I do (PACU) the screenings I like are tobacco, drug use and STOP-BANG. People that smoke, use narcotics on a regular basis and those that take anti-depressants, (for which a depression screening does not help me, I just look at the med list) it is harder to control their pain. I know that before I ever see them, they will probably need and be able to tolerate higher doses. It is also nice to know if they have diagnosed or lots of risk factors that mean they may have undiagnosed obstructive sleep apnea (which is what the STOP BANG scores for).

But with a average time of one-three minutes between being notified that the OR is turning and having the patient roll through the door, it isn't likely I'll have a chance to look up any screenings before I am caring for this patient and dealing with airway or pain issues. (I use those precious minutes to find out which patient it is and open their chart and associate them with monitors, and if I get that done, whoo hoo!)

I rely on the verbal report I get from the anesthesiologist for anything I need to know. They will let me know about the tobacco/drug use and any OSA they know of.... but they get that info from their interview, not from the screenings the pre-op nurse is working diligently to complete.

[JKL33]

Good topic. If I try to address it I fear it'll end up as a "wall of text". Suffice it to say that, just because people use the ED for primary care does not mean that the ED is a good place to institute one screen after another. It's not the place nor the time. Situations that involve (or are suspicious for involving) various social maladies will still be addressed - - the implementation of a screen is not what ever dictated that to begin with. Adequate staffing and good Nursing are things that allow issues to be addressed. Not screens.

One more thing: In the ED, before you know it you have a process that takes a significant amount of time. What that eventually translates to is someone else waiting who shouldn't be waiting.

[cutting myself off...]

[quazar]

I have been surprised on a number of occasions by the most innocuous looking patients giving the most shocking answers to screening questions. Had the questions not been there, I likely wouldn't have asked, and never would have known the (in some cases very large and dangerous) risk was there. Yes, the screening questions are annoying, but I think of them like a giant sieve: they are useful filters that catch small things that would otherwise be missed. You never know.

[KatieMI, BSN, MSN, RN]

I have been surprised on a number of occasions by the most innocuous looking patients giving the most shocking answers to screening questions. Had the questions not been there, I likely wouldn't have asked, and never would have known the (in some cases very large and dangerous) risk was there. Yes, the screening questions are annoying, but I think of them like a giant sieve: they are useful filters that catch small things that would otherwise be missed. You never know.

The problems with that are:

1) how are you going to make sure that those shocking answers indeed represent a problem,

and

2) what are you going to do next, especially in quite specific climate of ER.

All screens are innately prone to false positives, that's how they work. A high school kid who is feeling overwhelmed with tasks and life can score "positive" on depression screen when he sits in ER with CC on migraine, anxiety and loss of sleep but it doesn't mean he needs to be loaded with antidepressants, Xanax and something else. He might need help all right but it will be up to his school and parents to organize it, and the needed interventions might have nothing to do with healthcare.

Most problems patients are screened for require long term intervention with complex planning. If you just ask "do you smoke?" and "have you ever considered quitting?", thus "performing your mandated "tobacco screen", you do not "provided help and care". You are "justdoingyourjob" and satisfy some stats guy sitting somewhere in insurance office but it is way more likely that the patient just shrugs it off as yet another silly question "they ask me every single time".

[JKL33]

I have been surprised on a number of occasions by the most innocuous looking patients giving the most shocking answers to screening questions. Had the questions not been there, I likely wouldn't have asked, and never would have known the (in some cases very large and dangerous) risk was there. Yes, the screening questions are annoying, but I think of them like a giant sieve: they are useful filters that catch small things that would otherwise be missed. You never know.

I have no doubt that screening can be very useful in various settings or when performed in specific ways

I must say that I can't recall a time that I was shocked about a reply to a screening question. Please know I'm not saying that to be argumentative or to question your own personal experiences.

There may be different methods - such as being able to answer a question on a computer screen, or having the screen take place in private that "make sense" in my mind as things that might produce more useful results.

But in the ED the setting is thus: We're already putting every single patient through our giant sieve to filter out existing physical ailments that might kill someone in the next 24 hours. We don't have the time to figure out if we should exclude visitors from this screen or anything like that. We don't have time to sit and ask our screening questions in a therapeutic/open-ended way. We need to get everyone who is waiting through the "emergent physical problem" sieve ASAP.

The effect, therefore, is that I will be mostly looking at a computer screen, clicking or typing, and you will be sitting in a chair next to your partner, your boss, or your grandchild or 10 of your closest friends, when I ask you if you are in a safe living situation 0.5 seconds after you answer whether or not you smoke, which was asked 0.5 seconds after I asked you if you have any allergies...and you'll answer those questions with your child, your friend, your boss, your abuser, your pimp...whoever, standing right there with you.

Or in the case of smoking...15 years ago when you'd ask someone that question they might lie, they might answer sheepishly, etc. Nowadays, they know the routine. They say "yep!" They know we're moving right on to the next question just like Katie mentioned above. Our ED screening routines have been successful at letting them know that we don't care about the answer, and nothing is going to be done about it.

[KatieMI, BSN, MSN, RN]

Our ED screening routines have been successful at letting them know that we don't care about the answer, and nothing is going to be done about it.

You do not care for the answer, just about the fact of it. Iamjustdoingmyjob, classic edition. I do not blame ER nurses for doing that, though - unfortunately, we all have to play the same game.

Last time in ER, once RSI was off, I was lying down with tube fresh down my throat blinking "yes" and "no" on all those questions about smoking, suicide and domestic abuse. I guess, should I feel as making a little fun out if it, I would be known as the first person ever to attemp a suicide by purposefully sampling food which might be contaminated by known allergen, then sheepishly subject oneself to adrenaline, tube and everything else.

[NurseSpeedy, ADN, LPN, RN]

The system that I work for recently changed (and added) screening questions to the admission. The pain questionnaire just got more involved and had several questions regarding how it impacted various aspects of life. I'm just rambling off the list for a yes or no answer when I finished reading "increased irritability". I stared at the screen for a moment before saying, "okay, now that question is just stupid". Patient couldn't stop laughing as we continued down the list of never ending admission questions.

[Daisy4RN]

Yes, yes, yes, there are way too many screening questions and they (usually) do more harm than good. When a patient is admitted the RN should be more focused on the problem that brought them to the hospital than the fact that they have been smoking for 30 years and have no intention of quitting now, a complete waste of time/resources. Maybe in a different setting other than acute care hospital might work. But in the acute care setting the questions are way too many, not relevant, and take way too much time from already stressed out nurses. Maybe if the hospital hired someone other than the bedside nurse it might work. Nurses just get more and more work dumped on them everyday which just makes patients less safe.

[JKL33]

You do not care for the answer, just about the fact of it. Iamjustdoingmyjob, classic edition. I do not blame ER nurses for doing that, though - unfortunately, we all have to play the same game.

Hi Katie,

I think we agree? My last sentence involved kind of a resigned sarcasm, as in....unfortunately that's all we've accomplished, is to send the message that we're not getting to hung up on any of these questions, we just need to click a box. I'd like to care, and I would care if I were in a different situation. I think that's what you were saying too.

I think it sucks to be in a position to ask some of those questions when the sum total of my rapport with the patient thus far is "Hi, there. What brings you in today?" ... "Okay, I can see you have a rash there...by the way, is your living situation safe? Anyone hurting you? Any allergies to medications?" [That's not exactly how it goes, obviously, but that's what it feels like to both nurse and patient]...

[KatieMI, BSN, MSN, RN]

Hi Katie,

I think we agree?

Looks like we are!

[Boomer MS, RN]

Hi Katie,

I think we agree? My last sentence involved kind of a resigned sarcasm, as in....unfortunately that's all we've accomplished, is to send the message that we're not getting to hung up on any of these questions, we just need to click a box. I'd like to care, and I would care if I were in a different situation. I think that's what you were saying too.

I think it sucks to be in a position to ask some of those questions when the sum total of my rapport with the patient thus far is "Hi, there. What brings you in today?" ... "Okay, I can see you have a rash there...by the way, is your living situation safe? Anyone hurting you? Any allergies to medications?" [That's not exactly how it goes, obviously, but that's what it feels like to both nurse and patient]...

I certainly agree for the reasons listed in the previous posts. It's more of bureaucracy gone a bit mad.

And do I see a change in KatieMI's name? Did she receive her MSN? If so, warm congratulations.