Mental Health Screening in a Rural Trauma Center: Feasibility and Impact.

Abstract

Background: Trauma survivors often develop psychological sequelae, namely depression and post-traumatic stress disorder. Identifying and treating at-risk patients in rural trauma centers is challenging due to resource limitations, a gap not previously addressed in the literature.

Objective: To assess the feasibility and impact of a mental health screening initiative in a rural trauma center.

Methods: This quality improvement study used a quasi-experimental design to evaluate the feasibility and impact of a mental health screening initiative over 2 years (2022-2024) in a rural Northwestern U.S. Level II trauma center. We compared screening compliance, resource provision, and psychiatric consultation rates between the implementation (August 2022-July 2023) and post-implementation years (August 2023-July 2024). The inclusion criteria included trauma patients aged ≥18 years, with a Glasgow Coma Scale > 14, and who were admitted ≥ 2 days. The target screening compliance rate was set at ≥ 80%.

Results: Of the 1,114 eligible patients, 938 (84.2%) were screened, with 314 (33.5%) screening positive for psychological sequelae. All positive screen patients received a resource pamphlet and psychiatric consultation offers, resulting in 34 (10.8%) receiving formal evaluations. Missed screening opportunities decreased from 20.5% (95% CI [16.7, 24.4]) in the implementation year to 13.6% (95% CI [9.0, 18.2]) (p = .022) in the post-implementation year.

Conclusion: Mental health screening proved feasible in a rural trauma center, achieving 84.2% screening compliance. Despite barriers of limited staff availability and manual documentation, missed screening opportunities decreased. However, with only 10.8% of positively screened patients receiving psychiatric consultations, substantial systemic barriers remain to be addressed.