Background: Blood lead screening is a critical preventive health element of pediatric well-child appointments, as exposure to lead can lead to developmental delays and many other serious health consequences. However, research shows that clinics face difficulty carrying out lead screening recommendations. This project evaluated rates of lead screening at the UT St. Francis Family Medicine Residency clinic according to the Tennessee Department of Health (TN DOH) guidelines and proposed quality improvement strategies based on several factors that potentially prevent routine screenings.

Methods: A retrospective chart review was conducted using a random sample of 353 pediatric patients aged 12 to 72 months who had established UT-St. Francis as their primary care clinic. We utilized a retrospective chart review to determine if patients had 12- and 24-month well-child appointments, if lead screenings were completed at these times, and blood lead levels reported at each screening. We also investigated whether any acute medical issues were coded in patient charts for these well-child encounters and rates of “catch-up” screenings among patients who had never been screened for lead. To assess physician awareness of lead screening recommendations, an anonymous questionnaire was distributed to the UT St. Francis Family Medicine residents, attendings, and fellows.​

Results: 47% of the sampled patients were screened for lead at 12-month well-child appointments, and 26% were screened at 24 months. This study identified several likely clinical barriers to the completion of the TN DOH recommended lead screenings, which included clinical workflow and few systems-based reminders but excluded physician awareness. Based on these results, we developed several suggestions for future quality improvement projects.

Conclusions: Our recommendations directly address the identified causes of missed screenings from this study’s analyses and hold potential to increase future lead screening rates based on the clinic’s specific needs. Our primary recommendation is to introduce automated EHR alerts to notify physicians about needed lead screenings beginning at 12 months with recurring alerts when patients require a catch-up screening. In September 2023, this recommendation was integrated into the clinic EMR system. Future study should investigate the short- and long-term effects of these recommendations on subsequent lead screening rates.

References and Resources

1. CDC. “Lead (Pb) Toxicity: Who Is at Risk of Lead Exposure? | Environmental Medicine | ATSDR.” www.atsdr.cdc.gov, 9 Feb. 2021, www.atsdr.cdc.gov/csem/leadtoxicity/who_at_risk.html.