Study finds positive outcomes associated with universal screening and referrals for social needs in emergency rooms

Findings in a recent University of Utah preliminary study suggest that there might be positive outcomes associated with implementing universal screening and referrals for social needs in emergency rooms. The researchers believe that the findings may support the idea of implementing universal screening and referrals for social needs as regular components of emergency room protocols.

Social needs, including food and housing, play a role in up to 75% of health outcomes, according to the U.S. Office of Disease Prevention & Health Promotion. According to the researchers, this causes many patients with unmet needs to repeatedly rebound into ERs. Making this point, they point to data which suggests that up to 25% of patients use ERs as their usual source of medical care due to cost barriers which prevent low income patients from receiving treatment.


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Reducing these recurrent ER visits through referrals to social service agencies could, according to the researchers, slash emergency room costs and increase efficiency.

People seeking care in emergency rooms face many circumstances in their personal lives that are barriers to remaining healthy after they receive care,” says Andrea Wallace, the study’s lead author and chair of the Division of Health Systems and Community Based Care in the College of Nursing at University of Utah Health. “The truth is, we can do everything we can for patients in the context of emergency room care, but it’s not going to matter if they can’t properly engage in self-care after they leave.”

To analyze the potential outcomes associated with reducing recurrent ER visits recurrent ER visits through referrals and screening, the researchers tested a new tool they developed that assesses the social needs of ER patients and subsequently refers them to up to 46 community resources available through United Way 211 (UW211), a nonprofit emergency services referral hotline.

The social needs assessment was conducted through a a 10-item questionnaire broken down into nine categories: housing and utilities; food assistance; transportation needs; medical, dental, and vision insurance; employment; education and training; and child care and elder care.

61 percent of the 210 patients surveyed had one or more unmet social need, such as lacking sufficient access to food, clothing, or medical care. Over 50 percent of respondents requested referrals to social service agencies.

The researchers also found that patients who requested them received an average of four referrals from UW 211. The most common type of referrals were health care related, such as to community clinics and prescription drug discounts.

The researchers took care to note that study has several limitations, including that “it was conducted at only one hospital ER, most of the participants were white, and registration staff occasionally skipped screening patients because they had insurance, were well-groomed, or appeared to be financially secure.”

The point of this small study was to see if we could conduct initial social needs screening in the ER with existing resources, then have follow-up conducted by community-based agencies,” Wallace says. “We plan to conduct larger, more diverse studies to determine if and how this concept can be integrated into other hospital settings, and whether it benefits patients.”