Homelessness and Emergency Medicine: A Review of the Literature

Salhi, Bisan A.; White, Melissa; Pitts, Stephen R.; Wright, David W.

doi:10.1111/acem.13358

Cited by 106 publications

(103 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Australian research mapping the spatial dynamics of homelessness found that inner city and remote (in particular northern and central Australian) local government areas had the highest share of homelessness, increasing the likelihood of hospitals in these regions servicing homeless individuals. Therefore while our study also found frequent use of hospital ED services by homeless patients, multiple factors need to be considered by health services wanting to determine local homeless prevalence …”

Section: Discussionmentioning

confidence: 62%

Homeless status documentation at a metropolitan hospital emergency department

Lee

Thomas

Newnham

et al. 2019

Emerg Medicine Australasia

View full text Add to dashboard Cite

Objective: This study compared the prevalence of homelessness in consecutive patients presenting to a metropolitan hospital ED measured via a prospective housing screen with the prevalence of homelessness determined via retrospective audit of hospital data. Factors that altered the odds of patients being homeless and service outcomes that differed were examined for screened patients. Methods: All patients presenting to the ED during a 7 day period in 2017 were invited to complete a housing screen. A retrospective audit of all ED presentations during the same period also occurred. Demographic (e.g. age, gender), clinical (e.g. reason for presentation, ED presentation history) and arrival mode (e.g. time, how arrived) predictors of homeless status were examined alongside care outcomes (e.g. ED length of stay, admission and 28 day re-presentation). Results: Of 1208 presenting patients, 504 were prospectively screened and 7.9% were homeless. This compared with 0.8% of ED presentations coded as homeless in the Victorian Emergency Minimum Dataset and 2.3% of the 704 non-screened patients identified as homeless using Victorian Emergency Minimum Dataset Usual Accommodation alongside primary diagnosis and registration address. Within the screened sample, homeless patients were more likely to be male, arrive by emergency ambulance/with police, have a psychosocial diagnosis, and be frequent presenters. Representation within 28 days occurred for 43% of homeless and 15% of not-homeless patients. Conclusions: Hospital ED administrative data substantially under-recognises the prevalence of homelessness in presenting patients. Standardised use of brief housing screens could improve identification of and provision of support to this often highly vulnerable population.

show abstract

Section: Discussionmentioning

confidence: 62%

Homeless status documentation at a metropolitan hospital emergency department

Lee

Thomas

Newnham

et al. 2019

Emerg Medicine Australasia

View full text Add to dashboard Cite

show abstract

“…This study was conducted among a very unique subpopulation of ED patients and did not specifically explore pathways to homelessness. Homelessness plays an oversized role in U.S. EDs, in part due to the ED's role as a medical and social safety net and in part due to the greater than average health needs of people who are homeless . Research spanning multiple localities and types of EDs has found that a disproportionate number of ED patients are homeless .…”

Section: Discussionmentioning

confidence: 99%

“…Homelessness plays an oversized role in U.S. EDs, in part due to the ED's role as a medical and social safety net and in part due to the greater than average health needs of people who are homeless . Research spanning multiple localities and types of EDs has found that a disproportionate number of ED patients are homeless . Other research has found that ED providers struggle to provide optimal care to patients who are homeless, which may lead to provider burnout …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

“It Wasn't Just One Thing”: A Qualitative Study of Newly Homeless Emergency Department Patients

Doran

Ran²,

Castelblanco

et al. 2019

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: Emergency departments (EDs) frequently care for patients who are homeless or unstably housed.One promising approach taken by the homeless services system is to provide interventions that attempt to prevent homelessness before it occurs. Experts have suggested that health care settings may be ideal locations to identify and intervene with patients at risk for homelessness, yet little is known even about the basic characteristics of patients who might benefit from such interventions.Methods: We conducted in-depth, one-on-one qualitative interviews with ED patients who had become homeless within the past 6 months. Using a semistructured interview guide, we asked patients about their pathways into homelessness and what might have prevented them from becoming homeless. Interviews were digitally recorded and professionally transcribed. Transcripts were coded line by line by multiple investigators who then met as a group to discuss and refine codes in an iterative fashion.Results: Interviews were completed with 31 patients. Mean interview length was 42 minutes. Four main themes emerged: 1) unique stories yet common social and health contributors to homelessness, 2) personal agency versus larger structural forces, 3) limitations in help from family or friends, and 4) homelessness was not expected.Conclusions: These findings demonstrate gaps in current homeless prevention services and can help inform future interventions for unstably housed and homeless ED patients. More immediately, the findings provide rich, unique context to the lives of a vulnerable patient population commonly seen in EDs.

show abstract

“…Health policy, material deprivation, inequality, and stigma are implicated in poor health outcomes among emergency department (ED) patients . Researchers have emphasized the role of the social determinants of health, structural racism, gender discrimination, homophobia, and transphobia on the health of ED patients. These topics continue to gain interest and attention as their ties to medical education, clinical care, and population health are elucidated and emphasized.…”

mentioning

confidence: 99%

Toward Structural Competency in Emergency Medical Education

Salhi

Tsai

Druck

et al. 2019

AEM Education and Training

Self Cite

View full text Add to dashboard Cite

As the emergency department (ED) is the "front door" of the hospital and the primary site by which most patients access the health care system, issues of inequity are especially salient for emergency medicine (EM) practice. Improving the health of ED patients, especially those who are stigmatized and disenfranchised, depends on having emergency physicians that are cognizant and attentive to their needs in and out of the medical encounter. EM resident education has traditionally incorporated a "cultural competency" model to equip residents with tools to combat individual bias and stigma. Although this framework has been influential in drawing attention to health inequities, it has also been criticized for its potential to efface differences within groups (such as socioeconomic differences), overstate cultural or racial differences, and unintentionally reinforce stereotypes or blaming of patients for their ill health or difficult circumstances. In contrast, emerging frameworks of structural competency call for physicians to recognize the ways in which health outcomes are influenced by complex, interrelated structural forces (e.g., poverty, racism, gender discrimination, immigration policy) and to attend to these causes of poor health. We present here the framework of structural competency, extending it to the unique ED setting. We provide tangible illustrations of the ways in which this framework is relevant to the ED setting and can be incorporated in EM education.From the

show abstract

Homelessness and Emergency Medicine: A Review of the Literature

Cited by 106 publications

References 80 publications

Homeless status documentation at a metropolitan hospital emergency department

Homeless status documentation at a metropolitan hospital emergency department

“It Wasn't Just One Thing”: A Qualitative Study of Newly Homeless Emergency Department Patients

Toward Structural Competency in Emergency Medical Education

Contact Info

Product

Resources

About