Screening for health-related social needs in the emergency department: Adaptability and fidelity during the COVID-19 pandemic

Abstract

Background and objectives We sought to evaluate a screening and referral program for health-related social needs (HRSN) in our ED. Our goals were to (1) quantify successful screenings prior to and during the initial peak of the pandemic, and (2) describe the HRSNs identified. Methods We performed an observational analysis of ED-based screening for HRSN in Medicare and Medicaid patients at our large urban safety-net hospital. Screening was performed by patient navigators utilizing the ten question, validated Accountable Health Communities (AHC) Screening Tool, which screens for food insecurity, housing instability, transportation needs and utility assistance and interpersonal safety. Patients who screened positive for HRSN were provided with handouts listing community resources. For patients with two or more self-reported ED visits in the last 12 months and any identified HRSN, ongoing navigation after discharge was provided utilizing community resource referrals. During the pre-pandemic period from November 1, 2019 – January 31, 2020, screening occurred in-person. Screening during the pandemic from March 1, 2020 – May 31, 2020 occurred remotely via telephone. Descriptive statistics including frequency rates and percentages were calculated. Successful screening was defined as completing the screening survey with a navigator and being triaged to either no assistance, resource handouts, or navigation services. Results Among the adult and pediatric patients screened for HRSN, 158 (16%) qualified for community resource handouts and 440 (44.4%) qualified for patient navigator services. The proportion of patients receiving both resources and care navigation remained similar in the pre- and post-periods of the study, at 227 (45%) and 213 (43.9%) respectively. However, the proportion of ED patients with a HRSN need doubled from 56 (11.1%) in the pre-period to 102 (21%) in the post-period. Food insecurity was the most identified HRSN in both the pre-pandemic period (27.3%) and during the pandemic (35.8%). Conclusion We found that remote HRSN screening for ED patients during the COVID-19 pandemic resulted in similar proportions of successfully completed screenings compared to pre-pandemic efforts. This demonstrates the feasibility of utilizing alternative methods of screening and referral to community resources from the ED, which could facilitate this type of intervention in other EDs. During the pandemic HRSN increased, likely reflecting the economic impact of the pandemic.

Social determinants of health screening in pediatric healthcare settings

“…Although the COVID-19 pandemic significantly impacted rates of well child care and vaccinations, outpatient clinics were faced with challenges for how to continue conducting SDOH screening. Options studied in the literature included telephone encounters [36,38]. Such barriers to screening were juxtaposed with the increased importance of identifying and addressing SDOH during the pandemic.…”

“…Approaches vary from a universal resource offering to a screening-targeted resource referral [42]. On the basis of the Centers for Medicare and Medicaid Services Accountable Health Communities (AHC) pilot [5], many healthcare systems are using ‘tiers’ of services to ensure appropriate allocation of scarce community resources [42,38].…”

Evaluating a social risk screening and referral program in an urban safety‐net hospital emergency department

“… 7 , 14 , 15 There has been growing interest in the past 2 decades in expanding social needs screening and referral programs to the ED. 7 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 34 …”

ED‐Home: Pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use

“…Two focused on frequent ED users who were homeless with concomitant substance use issues, 6,7 one examined an ED‐based primary care clinic, 8 and one sought to increase vaccination 9 . A few other studies have examined more general “help desk” or “screening and referral” interventions to address a wide range of ED patient social needs 10–13 . These studies have generally been limited in their study design (e.g., lack of a comparison group, sparse outcome assessment).…”

“…9 A few other studies have examined more general "help desk" or "screening and referral" interventions to address a wide range of ED patient social needs. [10][11][12][13] These studies have generally been limited in their study design (e.g., lack of a comparison group, sparse outcome assessment).…”