Universal Depression Screen of Ambulatory Cardiac Transplant Recipients is Feasible and Identifies a Subset of Patients That May Benefit from Mental Health Intervention

Purpose Patients with a heart transplant who have depression have higher rates of graft failure and noncompliance; however, patients identified and treated early have outcomes similar to those without depression. The aim of this quality improvement project was to assess feasibility of implementing a universal depression screen—via the Patient Health Questionnaire (PHQ)-in a busy ambulatory heart transplant clinic. Methods Heart transplant team members were educated via an online module about depression screening. The PHQ was embedded in the electronic health record. Depression screening (PHQ2) was performed by an RN during the check-in process. For those patients who screened positive for depression (PHQ2 ≥3), the PHQ9 was administered. Patients who scored positive for moderate or severe depression (PHQ9 ≥10) received a follow-up phone call and referral to mental health services. Primary outcomes were the percentage of patients who underwent successful depression screening and received follow-up. Secondary outcomes included average time for completion of depression screening and level of burden for team members (5-point Likert scale, 5=significant burden, 1=no burden at all). Results From July-September 2018, there were 388 clinic visits; PHQ2 screens were completed during 363 (94%) of those visits. There were 223 unique patients seen during this time, of which 214 underwent a depression screening assessment. Initial PHQ2 identified 21 patients (6%) who screened positive for depression, of which all 21 had PHQ9 assessment. The PHQ9 identified 17 patients (4%) as having moderate or severe depression. All 17 patients were provided with mental health resources and received follow-up phone calls. Median time to administer PHQ2 was 2 minutes (range 1-2). Median time to administer PHQ9 was 5 minutes (range 5-15). Mean transplant provider burden score for depression screening was 1.6 (range 1-2). Conclusion Implementation of routine universal depression screening in an outpatient heart transplant clinic is feasible, identifies patients with depression, and does not result in clinical burden. Further investigation is needed to determine whether this universal depression screening and resultant early referral to mental health services positively effects long-term graft and patient survival.