Navigating the boundaries of emergency department care: Addressing the medical and social needs of patients who are homeless

K.M. Doran, A.A. Vashi, S. Platis, L.A. Curry, M. Rowe, M. Gang and F.E. Vaca

American Journal of Public Health, 2013, vol. 103, issue S2, S355-S360

Abstract: Objectives. We sought to understand interpersonal and systems-level factors relevant to delivering health care to emergency department (ED) patients who are homeless. Methods. We conducted semistructured interviews with emergency medicine residents from 2 residency programs, 1 in New York City and 1 in a medium-sized northeastern city, from February to September 2012. A team of researchers reviewed transcripts independently and coded text segments using a grounded theory approach. They reconciled differences in code interpretations and generated themes inductively. Data collection and analysis occurred iteratively, and interviews continued until theoretical saturation was achieved. Results. From 23 interviews, 3 key themes emerged: (1) use of pattern recognition in identifying and treating patients who are homeless, (2) variations from standard ED care for patients who are homeless, and (3) tensions in navigating the boundaries of ED social care. Conclusions. Our study revealed practical and philosophical tensions in providing social care to patients in the ED who are homeless. Screening for homelessness in the ED and admission practices for patients who are homeless are important areas for future research and intervention with implications for health care costs and patient outcomes.

Keywords: article; emergency health service; female; health personnel attitude; homelessness; hospital admission; human; interpersonal communication; interview; male; medical education; mental disease; organization and management; patient acuity; social work; United States; emergency health service; Mental Disorders; organization and management, Attitude of Health Personnel; Communication; Emergency Service, Hospital; Female; Homeless Persons; Humans; Internship and Residency; Interviews as Topic; Male; Mental Disorders; New York City; Patient Acuity; Patient Admission; Social Work, Attitude of Health Personnel; Communication; Emergency Service, Hospital; Female; Homeless Persons; Humans; Internship and Residency; Interviews as Topic; Male; Mental Disorders; New York City; Patient Acuity; Patient Admission; Social Work (search for similar items in EconPapers)
Date: 2013
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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2013.301540_6

DOI: 10.2105/AJPH.2013.301540

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