South Dakota

South Dakota Partnership Strengthens Pediatric Lead Screening to Protect Young Children

In South Dakota, too many young children were missing critical blood lead level (BLL) screenings during routine well-child visits—despite the well-documented risks of lead exposure to a child's health and development. In 2022, although 64% of children were insured through Medicaid or the Children's Health Insurance Program (CHIP), only 33% of eligible children received the required blood lead test. This gap was particularly concerning at 12 and 24 months of age, when early detection is essential to prevent long-term cognitive and developmental harm.

To address this challenge, Sanford Health pediatric residents, faculty, and the South Dakota Childhood Lead Poisoning Prevention Program launched a comprehensive, one-year quality improvement initiative. The team identified key barriers—including inconsistent screening practices and limited awareness of updated guidelines—and implemented targeted solutions. These included healthcare provider education sessions, integration of electronic medical record (EMR) reminders to prompt screening at recommended well-child visits, and dissemination of clear, evidence-based follow-up algorithms. The state's shift from risk-based to universal screening further standardized expectations and strengthened alignment between clinical care and public health priorities.

The results demonstrate the power of coordinated public health and clinical action. After implementation, 95% of clinicians reported screening more often for lead, 82% were more likely to screen compared to six months prior, and 68% found EMR reminders very helpful. By embedding screening prompts into routine workflows and reinforcing best practices through education and partnership, South Dakota is improving early detection of lead exposure and protecting more children from preventable harm—showcasing how public health departments can drive sustainable, system-level change.