Implementation of Social Media Screening into the Adolescent Well Visit

Abstract

Introduction: Adolescent social media use is at an all-time high and is associated with worsening mental and physical health. The American Academy of Pediatrics advocates for social media screening and counseling, which is infrequently performed in primary care. This project aimed to increase social media screening and counseling at our internal medicine-pediatric resident clinic during adolescent well visits from 0% to 50% during 6 months and to sustain this increase for an additional 12 months.

Methods: Residents used the Model for Improvement to target the key drivers of decreased screening. Each Plan-Do-Study-Act cycle involved the implementation of interventions and the collection of data to evaluate their effectiveness. Two documentation macros were created to track screening and anticipatory guidance. The monthly chart review yielded percentages of charts with documented social media screening and anticipatory guidance.

Results: Data were collected during 21 months. An average of 27.3 ± 3.18 charts per month met the inclusion criteria. The clinic achieved social media screening in more than 50% of 12- to 17-year-old well visits within 1 month, but it took 9 months to reach sustainability. Once reached, screening was sustained at a rate exceeding 50% for more than 12 consecutive months. Documentation of anticipatory guidance in more than 50% of visits only occurred during 2 nonconsecutive months.

Conclusions: We successfully implemented and sustained social media screening in more than 50% of adolescent well visits. Simple interventions made this project feasible in a multiphysician resident clinic. Barriers included a lack of documentation and macro integration into electronic note templates, as well as frequent physician turnover in a resident clinic. Anticipatory guidance documentation was below the goal but likely underreported.

Fig. 1.

Fishbone diagram describing the possible causes of low social media use screening, and anticipatory guidance at the clinic.

Fig. 2.

Key driver diagram outlining the project’s aim with key drivers and interventions.

Fig. 3.

Control chart (p-chart) with the percentage of documented social media screening at adolescent well-child visits. The timing of interventions is detailed in Table 1. Boxes with arrows indicate the timing of some interventions.

Fig. 4.

Control chart (p-chart) with the percentage of documented social media anticipatory guidance at adolescent well-child visits. The timing of interventions is detailed in Table 1. Boxes with arrows indicate the timing of some interventions.

Fig. 5.

Control chart with average visit length in minutes pre- and postimplementation of the project. Visit length is defined as the total time from check-in/arrival to discharge at the end of the clinic visit.