Individuals experiencing homelessness drastically overutilize emergency department (ED) services compared to non-homeless individuals (Ku et al., 2014). Many unhoused individuals have serious medical and psychosocial needs, which are chronic in nature, and become exacerbated due to poor management while living on the streets (Ku et al., 2014). The health needs of such individuals would be best managed through primary care continuity. However, care coordination becomes complex when a patient does not have a physical address or knowledge of available community resources (Mitchell, León, Byrne, Lin, & Bharel, 2017). By understanding the unique barriers that homeless and at risk homeless patients face, evidence-based public health and organizational interventions can be developed to incentivize outpatient services and deter inappropriate ED utilization (Mitchell et al., 2017). Yet, hospital data substantially underrecognizes the prevalence of patients experiencing homelessness because there is no universal documentation standard (Lee et al., 2019).

Research advises hospital leaders to implement a systematic method to socially triage patients, identify basic needs, and extend existing community resources (Ku et al., 2014). By requiring a standard two question screening process during ED triage asking "In the past two months, have you been in stable housing that you own, rent, or stay in as part of a household?” and "Are you concerned that in the next two months you may NOT have stable housing that you own, rent, or stay in as part of a household?”, the identification of unstably housed patients will improve so provisions of support such as social work consultations can be deployed during the hospital encounter (Lee et al., 2019). This simple initiative targeted toward unstably housed patients, has the power to reduce ED readmission rates, improve care quality and continuity, and promote organizational cost effectiveness (Ku et al., 2014).

Date of publication

Spring 4-19-2020

Document Type

MSN Capstone Project



Persistent identifier



Masters in Nursing Healthcare Administration