Homeless status documentation at a metropolitan hospital emergency department
Homeless status documentation at a metropolitan hospital emergency department
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DOI：
10.1111/1742-6723.13256
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发表时间：
2019-08-01
影响因子：
2.3
通讯作者：
Stafrace, Simon
中科院分区：
文献类型：
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作者：
Lee, Stuart J.;Thomas, Phillipa;Stafrace, Simon
目的本研究比较了通过前瞻性住房筛查和通过对医院数据的回顾审计确定的无家可归者在大都市医院急诊室就诊的连续患者的无家可归发生率。对筛查的患者进行了检查，检查了改变患者无家可归几率和服务结果的因素。方法邀请所有在2017年7天内到急诊室就诊的患者完成住房筛查。同时，还对同一时期的所有ED报告进行了回顾审查。人口统计学(如年龄、性别)、临床(如就诊原因、急诊就诊病史)和到达方式(如时间、如何到达)与护理结果(如住院时间、入院时间和28天再就诊)一起进行了检查。结果在1208例患者中，504例经过前瞻性筛查，7.9%的患者无家可归。相比之下，在维多利亚紧急情况最低数据集中，0.8%的急诊演示被编码为无家可归者，在使用维多利亚紧急情况最低数据集通常住宿和登记地址的704名未筛查患者中，2.3%被编码为无家可归者。在筛选的样本中，无家可归的患者更有可能是男性，乘坐紧急救护车/与警察一起到达，有心理社会诊断，以及经常出现。43%的无家可归者和15%的非无家可归者在28天内再次出现。结论：医院ED管理数据严重低估了住院患者中无家可归者的流行程度。标准化使用简短的住房屏风可以改善对这一往往高度脆弱的人口的识别和提供支持。
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. Re-presentation 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.