Supporting Emergency Department Patients Experiencing Homelessness

TL;DR

This paper discusses how emergency departments can better support homeless patients by addressing both medical and social needs.

Contribution

The paper introduces specific practice adaptations and programs to improve care coordination for homeless patients in emergency settings.

Findings

Early engagement and trauma-informed care improve outcomes for homeless patients.

Addressing nonmedical needs in the ED helps support patient movement through the department.

Sustainable solutions leverage existing programs and incentives.

Abstract

Homelessness is a growing public health crisis across the United States. Emergency physicians are uniquely positioned to address immediate medical concerns and the underlying social drivers of health for patients experiencing homelessness. Initiating coordination of care in the emergency department addresses their hierarchy of needs and can help support patient movement through the department. Practice adaptations described include early engagement; trauma-informed care approach; addressing unmet nonmedical needs; establishing safe dispositions; documenting homelessness, substance use disorder, and linkages to care; clinical practice adaptations; and palliative care approaches. Programs and initiatives outside of the emergency department described include street medicine and government initiatives. Sustainable solutions offered ideally use programs and incentives already available.

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