Raising our HEADSS: adolescent psychosocial documentation in the emergency department.
OBJECTIVE
To determine the effectiveness of a chart stamp featuring the acronym "HEADSS" (Home, Education, Alcohol, Drugs, Smoking, Sex) at improving adolescent psychosocial documentation in the emergency department (ED) chart.


METHODS
The study sample consisted of ten emergency physicians. The ED charts of 306 adolescent patients (aged 13-18 years) completed by these physicians were surveyed. An analysis of ED chart psychosocial documentation was conducted that compared a six-week control phase (with no chart stamp) with a four-week intervention phase (with a chart stamp featuring the HEADSS acronym). Presenting complaints in the ED, psychosocial documentation in the ED, and information from past medical records were compared between the two groups.


RESULTS
The ED charts surveyed consisted of 153 charts from each phase. HEADSS documentation ranged from 8% to 12% in the intervention phase and 0% to 7% in the control phase. Emergency physicians were more likely to document the topics of education (p = 0.029), alcohol (p = 0.045), and smoking (p = 0.009) as well as whether the patient was interviewed alone (p = 0.0001) in the intervention phase charts. Documentation of a detailed psychosocial assessment (>4/6 HEADSS topics addressed; p = 0.003) was more likely during the intervention phase.


CONCLUSIONS
The HEADSS stamp is useful in prompting psychosocial documentation in the ED chart. Further study is needed to determine whether routine use of the HEADSS stamp technique can improve the detection and management of adolescent psychosocial problems.
Van Amstel
Leanne L
LL
Department of Pediatrics and Department of Emergency Medicine, Izaac Walton Killam Health Center, Dalhousie University, Halifax, Nova Scotia, Canada.
Lafleur
Daniel L
DL
Blake
Kim
K
D000293:Adolescent; D000294:Adolescent Behavior; D004282:Documentation / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D008499:Medical Records; D001523:Mental Disorders / Q000175:diagnosis; D011446:Prospective Studies; D012919:Social Behavior