The following is a summary of “A descriptive study of screening and navigation on health-related social needs in a safety-net hospital emergency department,” published in the December 2023 issue of Emergency Medicine by Tubbs, et al.

Health-related social needs (HRSN) have emerged as significant factors linked to adverse clinical outcomes, heightened Emergency Department (ED) visits, and increased healthcare expenditures. Given its accessibility, the ED is a crucial setting for integrating HRSN screening into patient care and implementing effective interventions. For a study, researchers sought to assess whether navigation services for high-risk patients led to the resolution of identified HRSN.

They conducted HRSN screenings using the Accountable Health Communities Screening Tool on a convenience sample of patients from October 2019 to January 2022. Patients with HRSN were classified as high-risk if they had experienced at least two ED visits in the preceding 12 months. High-risk patients were eligible for navigation services, including community referrals and personalized follow-up. HRSN status (resolved, in progress, unable to resolve) was extracted from the Centers for Medicare and Medicaid database. The state hospital association obtained data on ED visits and inpatient hospitalizations within 6 months of the screening visit.

Among 185,470 ED visits, HRSN screening was conducted in 4050 (2%). Self-reported HRSN were identified in 48% (1944) of patient visits, with 71% (1,379) of these classified as high-risk. Notably, 15% of high-risk patients with HRSN opted out of navigation. Food insecurity emerged as the most prevalent HRSN (35%), followed by housing instability (26%), transportation needs (24%), and utility assistance (15%). Of these, food insecurity showed the highest resolution rate (39%), followed by utility assistance (37%), transportation needs (35%), and housing instability (28%), with significant proportions still in progress. High-risk visits where patients or guardians accepted navigation were associated with fewer subsequent ED visits within 6 months compared to those where navigation was declined (51% vs. 61%, P < 0.001), although no difference was observed in inpatient hospitalizations (P = 0.427).

During the study period, one-third of identified HRSNs were successfully resolved, with an additional one-third in progress. Notably, navigation services for high-risk patients were linked to reduced subsequent ED visits, underscoring the potential of such interventions in improving patient outcomes.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723004783