Action 5.07

Develop screening processes

Screening is used to identify existing conditions or issues that may predispose a patient to further harm, and to identify the level of risk for potential new harms to occur. The conditions, issues and risks identified through screening need to be properly assessed to determine what actions should be taken to manage them. Screening should shape the care delivered to a patient.

Many different conditions, issues and risks can potentially be identified through screening.

To develop appropriate screening processes for the health service organisation, consider:

• The cognitive, behavioural, mental and physical conditions and risks encountered by the patient population(s) served by the organisation
• The risks of harm identified in the Minimising patient harm criterion of this standard
• Feedback from quality improvement processes
• The capacity and type of services that the organisation provides.

Use this information to work with clinicians and consumers to develop screening and assessment processes that are appropriate to the needs of patients and the clinical service being provided, and are integrated into clinical workflow.

If one or more of the risks of harm identified in the Minimising patient harm criterion of this standard are not applicable to the organisation’s patient population, document the rationale for not including these risks in the organisation’s risk assessment processes.

Identify expectations about the timing of initial screening and assessment processes, and indications for repeated screening and assessment, in relevant policies, procedures and protocols.

Processes may vary for different groups of patients who attend the health service organisation and in different services. In some cases, different emphasis will be placed on screening versus comprehensive assessment. For example, in the anaesthetic assessment service, a detailed preoperative screening process may be needed to identify anaesthetic and surgical risks. In the geriatric section, screening processes may be minimal because patients routinely receive a thorough clinical assessment of the common conditions, issues and risks associated with older hospitalised patients.

Integrate screening and assessment

Integrate processes for screening and assessment, wherever possible. This means developing strategies to integrate:

• The multiple tools used to screen for common conditions and risks
• Screening activities with clinical assessment activities
• The input of multiple clinicians.

A recent audit of Victorian health services found more than 150 different screening and assessment forms in use across 11 health services.¹ Validated, integrated screening tools are not always available; however, significant Australian research is being undertaken in this area. Some health service organisations have developed their own integrated screening tools to reduce duplication of effort when patients are admitted.

Link screening activities to clinical decision-making and action when clinical risks are identified. This might mean ensuring that screening tools direct clinicians to the relevant assessments and interventions for managing an identified risk. For example, if a patient is identified as having cognitive impairment, specific assessments and clinical management strategies are recommended.¹

Integrate the screening and clinical assessment findings of multiple clinicians. This will reduce the need for patients, carers and families to repeat the same information multiple times to different clinicians. It will also help to ensure that the information gained through different professional assessments is addressed in clinical decision-making and incorporated into the comprehensive care plan. Strategies to foster integrated multidisciplinary screening and assessment activities include the use of:

• Shared electronic or paper-based screening and assessment tools and systems
• Shared ward rounds and clinics, multidisciplinary rapid rounding and multidisciplinary case conferencing
• Formalised communication strategies such as checklists, timeouts, multidisciplinary handover meetings and electronic patient journey boards.

Develop screening processes

Screening is used to identify existing conditions or issues that may predispose a patient to further harm, and to identify the level of risk for potential new harms to occur. The conditions, issues and risks identified through screening need to be properly assessed to determine what actions should be taken to manage them. Screening should shape the care delivered to a patient.

In day procedure services, different emphases will be placed on pre-admission screening and comprehensive assessment. Services may use a detailed preoperative screening process to identify anaesthetic and surgical risks. The day procedure service may not need comprehensive assessment processes if clinical conditions and risks identified through the screening process are largely managed by referring the patient to other services. Services will need to develop clear guidance about processes for refusing service when a patient’s clinical risks cannot be safely managed.

Many different conditions, issues and risks can potentially be identified through screening. To develop appropriate screening processes for the health service organisation, consider:

• The cognitive, behavioural, mental and physical conditions and risks encountered by the patient population served by the organisation
• The relevant risks of harm identified in the Minimising patient harm criterion of this standard
• Feedback from quality improvement processes
• The capacity and type of services that the organisation provides.
• Other aspects requiring screening (for example, medication safety, Aboriginal and Torres Strait Islander consumers, diversity under the Partnering with Consumers Standard).

Use this information to work with clinicians and consumers to develop screening and assessment processes that are appropriate to the needs of patients and the clinical service being provided, and are integrated into clinical workflow.

Patients who have specific conditions and risks of harm identified in screening processes may be referred elsewhere if further assessment and care are required. Develop admission protocols or policies that clearly outline criteria for admission.

Identify expectations about the timing of initial screening and assessment processes, and indications for repeated screening and assessment, in relevant policies, guidelines and procedures.

Integrate screening and assessment

Integrate processes for screening and assessment, wherever possible. This means developing strategies to integrate:

• The multiple tools used to screen for common conditions and risks
• Screening activities with clinical assessment activities
• The input of multiple clinicians.

Link screening activities to clinical decision-making and action when clinical risks are identified. This might mean ensuring that screening tools direct clinicians to the relevant assessments and interventions for managing an identified risk. For example, if a patient is identified as having cognitive impairment, specific assessments and clinical management strategies are recommended.¹

Examples of evidence

Select only examples currently in use:

• Organisational assessment of the risks relevant to the population serviced by the health service organisation
• Policy documents or by-laws that outline processes for conducting screening for, and assessment of, identified clinical conditions and risks, including those outlined in the ‘Minimising patient harm’ criterion, if relevant
• Resources and tools developed for pre-admission screening and assessment of clinical conditions and risks that are relevant to the health service organisation and risks outlined in the ‘Minimising patient harm’ criterion
• Employment documents that describe the roles, responsibilities and accountabilities for the workforce in relation to screening and assessment
• Training documents about the identification and assessment of at-risk patients
• Audit of screening and, if necessary, assessment processes on admission and at appropriate intervals during an episode of care.

MPSs and small hospitals will need to:

• Assess the risks and clinical requirements of the patients who use the health service organisation, and agree on relevant screening and assessment processes
• Ensure that the risks of harm identified in the Minimising patient harm criterion of this standard are addressed in these processes.

Screening is used to identify existing conditions or issues that may predispose a patient to further harm, and to identify the level of risk for potential new harms to occur. The conditions, issues and risks identified through screening need to be properly assessed to determine what actions should be taken to manage them. Screening should shape the care delivered to a patient.

Many different conditions, issues and risks can potentially be identified through screening. To develop appropriate screening processes for the health service organisation, consider:

• The cognitive, behavioural, mental and physical conditions and risks encountered by the patient population served by the organisation
• The risks of harm identified in the Minimising patient harm criterion of this standard
• Feedback from quality improvement processes
• The capacity and type of services that the organisation provides.

Use this information to work with clinicians and consumers to develop screening and assessment processes that are appropriate to the needs of patients and the clinical service being provided, and are integrated into clinical workflow.

Identify expectations about the timing of initial screening and assessment processes, and indications for repeated screening and assessment, in relevant policies, procedures and protocols.

Processes may vary for different groups of patients who attend the health service organisation and in different services. In some cases, different emphasis will be placed on screening versus comprehensive assessment. For example, in the anaesthetic assessment service, a detailed preoperative screening process may be needed to identify anaesthetic and surgical risks. In the geriatric section, screening processes may be minimal because patients routinely receive a thorough clinical assessment of the common conditions, issues and risks associated with older hospitalised patients.

Integrate screening and assessment

Integrate processes for screening and assessment, wherever possible. This means developing strategies to integrate:

• The multiple tools used to screen for common conditions and risks
• Screening activities with clinical assessment activities
• The input of multiple clinicians.

Link screening activities to clinical decision-making and action when clinical risks are identified. This might mean ensuring that screening tools direct clinicians to the relevant assessments and interventions for managing an identified risk. For example, if a patient is identified as having cognitive impairment, specific assessments and clinical management strategies are recommended.¹

Integrate the screening and clinical assessment findings of multiple clinicians. This will reduce the need for patients, carers and families to repeat the same information multiple times to different care providers. It will also help to ensure that the information gained through different professional assessments is addressed in clinical decision-making and incorporated into the comprehensive care plan. Strategies to foster integrated multidisciplinary screening and assessment activities include the use of:

• Shared electronic or paper-based screening and assessment tools and systems
• Shared ward rounds and clinics, multidisciplinary rapid rounding and multidisciplinary case conferencing
• Formalised communication strategies such as checklists, timeouts, multidisciplinary handover meetings and electronic patient journey boards.