Implementing the SWYC: A Quality Improvement Project and Its Impact on Care Delivery
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Background
Despite AAP recommending the use of validated developmental screening tools, national adoption remains low. To address this issue, we initiated a QI project to implement the Survey of Well-being in Young Children (SWYC) and assess its impact within our residency clinic. Our objective was to achieve over 50% screening coverage for well-child visits for children aged 8 to 33 months, with equitable implementation for both English-primary and non-English-primary speaking families. Additionally, we hypothesized that SWYC would significantly increase early intervention (EI) referral rates.
Methods
Patients aged 8 to 33 months attending well-child visits were included. During implementation, various interventions, including staff emails, daily huddles, and integration of SWYC into the electronic health record, were employed. As part of the clinic workflow, a designated social worker (SW) initiates EI referrals; thus, SW referrals served as a proxy for EI referrals. Referral rates were compared pre- and post-SWYC implementation. Statistical significance was assessed using a chi-square test in R software.
Results
SWYC utilization reached 50% within five months of implementation. Analysis showed no significant difference in SWYC use between English-primary and non-English-primary speakers (p = 0.13). Post-SWYC, SW referral rates increased by 34% compared to pre-SWYC rates (p = 0.009).
Conclusions
This QI project showcased the swift adoption of a standardized developmental screening tool through system and cultural changes. SWYC implementation significantly increased SW referral rates, suggesting improved identification of developmental delays. Standardized developmental screening has the potential to enhance developmental outcomes and promote care equity through objective assessment systems.
