Hospital readmission among the unsheltered population at a safety net hospital: A closer look at social work engagement

  • Niraj Gowda George Washington University School of Medicine and Health Sciences, Department of Internal Medicine, Washington, D.C.
  • Jameson Kuang University of South Florida Morsani College of Medicine, Department of Internal Medicine and Pediatrics, Tampa, Florida
  • Nadia Khalil University of South Florida Morsani College of Medicine, Department of Neurology, Tampa, Florida
  • Shruti Shankar University of South Florida Morsani College of Medicine, Department of Internal Medicine, Tampa, Florida
  • Ambuj Kumar University of South Florida Morsani College of Medicine, Department of Internal Medicine, Tampa, Florida
  • Lucy Guerra University of South Florida Morsani College of Medicine, Department of Internal Medicine, Tampa, Florida
  • Asa Oxner University of South Florida Morsani College of Medicine, Department of Internal Medicine, Tampa, Florida
  • Lynette Menezes University of South Florida Morsani College of Medicine, Department of Internal Medicine, Tampa, Florida

Abstract

Frequent utilization of emergency departments and crisis response services by individuals experiencing homelessness present a significant burden on hospital resources. On-site case management in the emergency department (ED) and the use of community health workers has shown potential for cost-effective reduction in ED utilization and improved clinical outcomes. To assess the impact of social work involvement and specific resources on patient disposition and hospital readmission rates for the homeless population, we conducted a retrospective review examining Tampa General Hospital's (TGH) ED utilization patterns among unsheltered or unstably housed adult patients between January 1, 2010 to December 4, 2017. There were 175 patients who met inclusion criteria accounting for 1824 total encounters. Social work services were engaged for 620 (34.0%) encounters. Discharge location was addressed during 395 (21.7%) encounters overall and only 84 (4.6%) encounters led to final placement in homeless shelters. Social work engagement was not associated with an increased likelihood of return to the ED within 60 days (when chief complaint was not taken into account), but was associated with readmission within 60 days (p-value < 0.001) and with return to ED with similar complaints (p-value = 0.038). In our cohort, social work intervention was underutilized, associated with increased readmission rates at 60 days, and addressed discharge location infrequently. Further research is needed to uncover the multifactorial etiologies accounting for this study's findings and to assess and optimize discharge planning.

Published
2021-10-18