Identification of Patients at Risk for Food Insecurity During the Anesthesia Preoperative Interview

Purpose: Food insecurity (FI) is a social determinant of health and health disparity that leads to increased risk of chronic health conditions. Despite the widespread implementation of FI screening in other settings, the role of the anesthesia team in FI screening is underused, increasing the chance of at-risk individuals not being identified. The anesthesia preoperative interview is an opportunity to identify patients experiencing FI and provide resources to improve outcomes. The purpose of this project was to evaluate and enhance FI screening practices in the preanesthesia testing (PAT) clinic. Design: Quality improvement project using a preintervention and postintervention design. Methods: This quality improvement project consisted of modifying the electronic health record to display current screening status, educating the PAT nurses on FI screening using the validated Hunger Vital Sign score, and automatically sending screening to patient portals upon PAT referral. Screening was conducted over 12 weeks, with weekly updates emailed to motivate staff and monitor consistency of screening efforts. At-risk patients were provided a resource packet to connect them to local, state, and federal resources. Demographic data were gathered to guide future targeted interventions. Findings: A total of 614 (72%) of 859 eligible patients were screened. Of those, 436 (71%) patients were screened by nursing staff, while 178 (29%) were screened within the patient portal. Fifty-four participants screened positive, and 22 were provided resource packets. Most patients experiencing FI identified as female (59.3%), Black or African American (57.4%), single (41%), and “disabled” as employment status (31%). Conclusions: The anesthesia preoperative interview serves as an opportunity to identify patients at risk of FI. This project concluded that patients of specific demographics were disproportionately affected by FI, providing a rationale for continued screenings. When a patient is identified as at risk, resources should be provided, and case management involvement may be necessary.

Duke Scholars

Author Virginia Chris Simmons School of Nursing