555 The Prevalence of Patients with Homelessness or Housing Instability in Patients Admitted to an Urban Burn Intensive Care Unit

Abstract

Introduction Patients with homelessness in the setting of burns experience more complications and longer lengths of stay (LOS), resulting in higher costs of care and recidivism rates, making appropriate screening and documentation critical to improving outcomes. However, the prevalence of housing instability and its effect on outcomes has not yet been studied. This study sought to describe the prevalence of housing insecurity, or homelessness and housing instability, in patients admitted to an urban burn intensive care unit (BICU) and compare their outcomes to their housed counterparts. Methods This is a retrospective cohort study of all adult patients admitted to our BICU over 3 years. The degree of burn injury and LOS were collected. We used the World Health Organization definitions of housing insecurity to identify patients. Physician and case management notes were used to evaluate housing status. Results There were 881 patients observed. The prevalence of patients with homelessness was 2.9 per 100 patients. The prevalence of patients with housing instability was 10.3 per 100 patients. The median length of stay was 8 (IQR 4 – 11) days for patients with homelessness and 4.5 (IQR 2 – 12) days for patients with housing instability compared to 4 (IQR 1 – 8) days for housed patients (P < 0.001). Patients with housing insecurity had similar injuries to housed patients (P = 0.06). Physicians incorrectly documented housing status in 42.9% of patients with housing insecurity compared to case management, which correctly screened all patients (P < 0.01). The electronic medical record correctly screened less than 1% of the patients with housing insecurity (P < 0.01). Conclusions Housing insecurity is more prevalent than previously thought, with 13.2 per 100 patients experiencing either homelessness or housing instability. These patients have similar injuries to their housed counterparts, with longer stays and higher health care costs. Identifying and implementing appropriate screening tools can help provider teams connect patients with resources, reducing costs and improving outcomes. Applicability of Research to Practice Identifying patients at high risk earlier in their care can ensure that they are provided with the appropriate resources to avoid complications and worse outcomes.