Homelessness a major issue for many patients in the emergency department

Housing insecurity is an issue for 1 in 20 patients who go to emergency departments at major medical centers in the Southeast, according to a Vanderbilt University Medical Center (VUMC) study published in JAMA Network Open.

These patients were more likely to present with a chief complaint of suicide, to be uninsured, and to have multiple visits during the study period from Jan. 5 to May 16, 2023. 

“This points to the importance of prioritizing mental health care and homeless health teams in hospital settings,” said lead author Madeleine Ball, a class of 2024 student in the Vanderbilt University School of Medicine and 2023-2024 Research Committee Lead for VUMC’s Homeless Health Service. 

“Directing resources toward patients who come to the emergency department regularly could have significant impact for patients. Our study emphasizes the utility of screening for homelessness in all acute care centers to best tailor and optimize care for this susceptible patient population.”

Study authors examined a total of 23,795 emergency department visits, using the Veterans Health Administration’s Homelessness Screening Clinical Reminder to screen for homelessness. 

Information from the questionnaire was combined with demographics, method of arrival, diagnoses, acuity, timing of presentation, disposition, and insurance status.

A total of 5% (1,185) screened positive for housing insecurity.

Unstable housing and homelessness can exacerbate adverse health outcomes, leading to increased risk of chronic disease, injury, and disability, the authors said, but emergency departments currently do not have a universal method to identify those at risk of, or currently experiencing, homelessness.

“Now that our team has made screening for housing insecurity common practice in the VUMC ED, we have several research questions to explore,” Ball said. 

“We plan to present a qualitative analysis of the implementation of this new screening process with a goal of answering a wide variety of research questions to optimize care for this patient population.”

Senior author Jennifer Hess, MD, assistant professor of Emergency Medicine in the Department of Emergency Medicine at VUMC, said she hopes the analysis provides a call for other institutions to introduce screening and create tailored care plans for patients experiencing housing insecurity.

“This project contributed a vital first step in advancing health equity by identifying who may benefit from resources and additional assistance,” Hess said. 

“We are grateful for the diverse, multidisciplinary team that allowed this project to happen and look forward to where it may lead. As homelessness and housing insecurity continue to rise throughout the country, we need to make it a priority to improve care for this susceptible and often overlooked patient population.”