The Effect of Homelessness on Patient Wait Times in the Emergency Department

Ayala, Alexander; Tegtmeyer, Kyle; Atassi, Giancarlo; Powell, Elizabeth

doi:10.1016/j.jemermed.2020.12.031

Cited by 9 publications

(12 citation statements)

References 29 publications

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“…Additionally, patients from neighborhoods with the lowest median income have longer transition times to their PIA, a result that echoes a prior study examining wait times in the unhoused population. 28 A previous study 29 identified that young adults experiencing homelessness have longer total ED stays, and the data presented here may highlight one factor for this in a SUD population. A theme that became apparent with this first state transition was that METH use was associated with prolonged time in the ED.…”

Section: Discussionsupporting

confidence: 52%

Flow Through the Emergency Department for Patients Presenting with Substance Use Disorder in Alberta, Canada

Edmundson,

Skoblenick,

Rosychuk

2023

WestJEM

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Introduction Since 2016 the province of Alberta, Canada, has seen a significant increase in substance use disorder (SUD) presentations to the emergency department (ED) with a large surge during the COVID-19 pandemic. In this retrospective study we deconstruct the total length of stay (LOS) in the ED into stages for patients presenting with SUD and estimate the effects of covariates on the time to transition between stages. Methods Using the Canadian Coding Standards for International Classification of Diseases, 10 th Modification, codes F10.0-F19.9 and T36.0-T50.9, we extracted data from the National Ambulatory Care Reporting System between April 1, 2019–March 31, 2020 on all ED presentations for SUD by Alberta residents. We used a multistate model to deconstruct the EDLOS into eight mutually exclusive states and determine which factors affected the time spent in each state. Results We analyzed 66,880 presentations (37,530 patients). The mean age was 37.2 years, and 61% were male. The median total LOS in the ED was 6 hours 13 minutes. Patients presenting with methamphetamines (METH) intoxication and patients from low-income neighborhoods had significantly increased transition times between all states. Opposite this, opiate use was associated with faster transition times between almost all states. Metro EDs experienced slower transitions when attempting to discharge or admit patients when compared to urban or rural EDs. Emergency department crowding also had a dramatic effect on physician initial assessment times, while discharge and admission times in patients presenting with SUD were also significantly affected. Conclusion Patients with SUD experience a variety of delays during their ED stay. Those with METH intoxication and those from the lowest income neighborhoods were most likely to experience slower transitions from state to state in the ED and may benefit from a focused approach to improve ED flow.

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Section: Discussionsupporting

confidence: 52%

Flow Through the Emergency Department for Patients Presenting with Substance Use Disorder in Alberta, Canada

Edmundson,

Skoblenick,

Rosychuk

2023

WestJEM

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“… 11 14 When attending an ED for what may appear to be routine healthcare, people experiencing homelessness are more likely to be assessed as a less urgent clinical priority than the general population, despite their complex healthcare needs. 13 This cohort are more likely to wait longer to receive care in ED 15 and leave before being seen by a health professional and then re-present at a later time. 16 EDs can provide a window of opportunity for intervention as well as delivering healthcare, and hold the potential to break the cycle of homelessness for thousands of people.…”

Section: Introductionmentioning

confidence: 99%

Development of the Homeless Health Access to Care Tool to identify health-related vulnerability among people experiencing homelessness: Delphi study, Australia

et al. 2022

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ObjectivesIn this paper, we report the development of the Homeless Health Access to Care Tool. This tool aims to improve the gap in assessing health need and capacity to access healthcare of people experiencing homelessness. Tools exist that prioritise people experiencing homelessness for housing, but none specifically designed to prioritise for healthcare, or that are succinct enough to be easily implemented to emergency department or primary healthcare settings.Design and settingThe Homeless Health Access to Care Tool has been adapted from an existing tool, the Vulnerability Index Service Prioritisation Decision Assistance Tool through a five-step process: (1) domain identification, (2) literature review, (3) analysis of hospital admission data, (4) expert judges, and (5) Delphi study.ParticipantsThe tool was adapted and developed by homeless health clinicians, academics and people with lived experience of homelessness. The Delphi study (n=9) comprised emergency department and homeless health clinicians.ResultsConsensus was gained on all but one item, five new items were added, and wording changes were made to six items based on expert feedback. Participants perceived the tool would take between 5 to 11 min to complete, the number of items were appropriate, and the majority agreed it would facilitate the assessment of health needs and capacity to access healthcare.ConclusionRobust development of the Homeless Health Access to Care Tool through the Delphi is the first phase of its development. The Homeless Health Access to Care Tool offers an opportunity to assess both health need and capacity to access healthcare with the aim to improve access to healthcare for people experiencing homelessness. This tool will facilitate standardised data collection to inform service design and data linkage regarding access to healthcare of people experiencing homelessness. The next stages of testing include construct validity, feasibility, usability and inter-rater reliability, and pilot implementation.

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“…Canadian researchers have shown that homeless people are heavy users of emergency services [5]. USbased research has shown that the homeless wait longer than domiciled patients to receive ED care [6].…”

Section: Introductionmentioning

confidence: 99%

Homelessness and Emergency Department Use: Wait Time Disparities Across Triage Acuity Levels

Weerasinghe,

Campbell

2023

Cureus

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IntroductionCertain patient groups perceive specific barriers to accessing primary care, resulting in increased emergency department (ED) use for non-emergency conditions. There is evidence coming from other countries that homeless people are treated differently in accessing emergency services. Examination of ED wait time by demographic characteristics provides pertinent information to identify subgroups that are more subject to the consequences or causes of access block and delayed treatment.

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The Effect of Homelessness on Patient Wait Times in the Emergency Department

Cited by 9 publications

References 29 publications

Flow Through the Emergency Department for Patients Presenting with Substance Use Disorder in Alberta, Canada

Flow Through the Emergency Department for Patients Presenting with Substance Use Disorder in Alberta, Canada

Development of the Homeless Health Access to Care Tool to identify health-related vulnerability among people experiencing homelessness: Delphi study, Australia

Homelessness and Emergency Department Use: Wait Time Disparities Across Triage Acuity Levels

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