Homelessness screening in the emergency department: Mending the holes in your safety net

Wednesday, June 1, 2016: 10:00 AM-11:30 AM
Galleria I (Hilton Portland)
Studies have demonstrated that large numbers of people experiencing homelessness access hospital emergency departments (EDs) for health care on a regular basis. Homelessness is associated with higher rates of morbidity with longer, more frequent hospital admissions. People experiencing homelessness have a length of stay almost twice as long as their housed counterparts and are more than twice as likely to be readmitted following a recent hospital stay. Persons without homes seen in the ED were three times more likely to have been seen in the same ED during the previous three days than stably housed persons; and more than twice as likely to be seen at an ED within one week following a hospitalization. The National Health Care for the Homeless Council estimates that 80 percent of ED visits by individuals experiencing homelessness can be prevented by adequate primary care—a staggering figure when considered within the context of health care utilization, outcomes, and cost. Despite this knowledge, institutions are unable to report actual utilization rates or costs of caring for patients who are homeless due to the challenges in documenting homelessness and housing instability. A literature review of articles published on use of the ED by people experiencing homelessness shows that identification was usually based on national databases intended for alternative use, self-reporting of homelessness, or simply querying addresses of local shelters—not screening all patients. This ultimately could lead to misleading data on homelessness since only segments of the population were identified and studied. The ability to accurately identify people experiencing homelessness on presentation to the hospital would ultimately allow for projections of utilization patterns and costs of caring for this subgroup, providing an invaluable springboard for Health Care for the Homeless programs in the way of operational planning, funding acquisition, outcomes evaluation, and prediction of future trends. It could thus provide an instrumental resource for clinical care teams (both inpatient and outpatient) as well as administrators. In order to begin addressing this complex issue, a research study was carried out at a large regional hospital network using a prospective survey method. A simple five-question survey was administered in three ED settings. Systematic screening revealed a much larger percentage of people experiencing homelessness than initially expected. The study revealed other significant findings including that there was no statistical significance with gender and homelessness. These findings ultimately led to permanent systematic screening in select locations and additional resources in the way of funding and staff for the institution's Health Care for the Homeless program. Presenters will share results from this study with an analysis of the findings. The homelessness screening tool, as well as best practices in screening in the Emergency Department, will also be shared. Tips on how to approach institutions to include homelessness screening will be discussed along with implementation and tracking strategies for various EMRs. Lastly, presenters will share uses of screening in improving patient care and tracking, with the goal of improved outcomes and to inform future services.
Brett Feldman, MSPAS, PA-C (Director and Founder Health Care for the Homeless/ Street Medicine, Lehigh Valley Health Network)
See more of: Workshop