Date of this Version

12-1-2025

Document Type

DNP Project

Abstract

Treatment-resistant depression (TRD) affects nearly one-third of individuals with major depressive disorder and is associated with severe impairment, increased hospitalizations, and higher suicide risk. Although transcranial magnetic stimulation (TMS) and intranasal esketamine (Spravato) are effective treatments, their use remains limited due to non-standardized referral processes, provider knowledge gaps, and workflow inefficiencies. These barriers contribute to delays in treatment and restricted access to advanced therapies. The purpose of this quality improvement project was to evaluate whether an educational intervention and standardized referral workflow could enhance provider knowledge and readiness to refer TRD patients for TMS and Spravato at South Florida Integrative Medicine (SFIM). A 20-item pre- and post-intervention survey was administered to seven psychiatric providers. The first 15 questions assessed knowledge of TRD, TMS, and Spravato, while the remaining five measured confidence, perceived barriers, and workflow adoption. The intervention included an evidence-based, voice-over PowerPoint module and distribution of a standardized referral workflow. Data were collected anonymously through Qualtrics and analyzed using descriptive statistics and paired-samples t tests. Provider knowledge scores improved significantly, increasing from a pretest mean of 8.43 (SD = 1.72) to a posttest mean of 12.29 (SD = 1.11), t(6) = –6.97, p < .001. Providers also reported higher confidence, fewer perceived barriers, and universal intention to adopt the standardized workflow. In conclusion, this project demonstrated that provider education combined with referral standardization significantly improved knowledge, confidence, and readiness to expand access to TMS and Spravato. Broader implementation of similar strategies may improve clinical outcomes and enhance patient access to evidence-based treatments for TRD.

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