272 Health-Related Social Needs in the Emergency Department: A Pilot Study

Abstract

The National Academy of Medicine (NAM) recently published recommendations for standardized screening for health-related social needs (HRSN), focusing on 5 domains: housing instability, food insecurity, transportation needs, utility needs, and interpersonal safety. Little is known about the extent of these needs in an emergency department (ED) population. Our objective in this study was to examine the prevalence of HRSN among patients in a large urban ED. We used publicly available questions in the 5 domains of the NAM recommendations to create a brief screener for HRSN in the ED. We then conducted 48 hours of time-shift sampling (24 hours of weekday and 24 hours of weekend) in the Fast Track and Pediatric areas of a large urban ED. Bilingual (English-Spanish) research assistants approached every arriving patient for enrollment during their shift; consenting patients or parents completed a brief demographic questionnaire and the HRSN assessment. We used standard descriptive statistics to describe the prevalence of HRSN, and a multivariable logistic model to assess the association between demographic factors and HRSN. We enrolled 131 participants, of whom 80 (61%) were adult patients in Fast Track and 51 (39%) were parents of pediatric patients; 77 (58%) were female and 14 (11%) completed the assessment in Spanish. Overall, 37 (29%) reported an HRSN: 17 (15%) reported housing instability, 22 (17%) reported food insecurity, 14 (11%) reported transportation needs, 8 (6%) reported utility needs, and 19 (15%) reported interpersonal safety concerns. In unadjusted analyses, HRSN were not associated with location of enrollment (Fast Track or Pediatrics) or sex, but were associated with language. In a multivariable model adjusting for location and sex, language remained significantly associated with presence of any HRSN (OR 4.15 [95% CI: 1.28-13.4]). Almost one-third of ED patients reported an HRSN in this pilot study, with Spanish-speaking patients at significantly higher risk. These data demonstrate the importance of HRSN screening in the ED, while also highlighting the significance of ensuring that screening programs and referral resources are accessible to non-English-speaking patients.