College

School of Nursing

Graduate Level

Doctoral

Graduate Program/Concentration

Doctor of Nursing Practice

Presentation Type

Poster Presentation

Abstract

Purpose statement: The purpose of this activity is to allow the learner to recognize the impact of a student-led clinic aimed at caring for those living in homelessness by providing accessible primary care and minimizing barriers to reduce avoidable emergency room utilization.

Objectives:

  1. At the end of the presentation, learners will be able to discuss and demonstrate knowledge of outcomes related to emergency room visits when student-led clinics are implemented in their region.
  2. To identify the most common reasons persons living in homelessness present to the emergency room to expand services in future practice.

Background: Studies have determined that unhoused patients have higher rates of emergency room (ER) utilization and are more likely to have repeated visits, with three-fourths of the visits categorized as inappropriate or avoidable (Salhi et al., 2017). In 2017 ER visits totaled over 76 billion (Moore & Liang, 2020). The average person living in homelessness visits the ER a minimum of five times a year, costing a minimum of 18,000 dollars (Garrett, 2012). Unhoused people face many barriers to accessing quality care and suffer from higher morbidity and mortality rates due to uncontrolled chronic conditions, untreated mental health, and unmet social needs. A homeless individual's life expectancy is less than 50 years old (Vohra et al., 2022). Multiple studies indicate that student-led free clinics are positioned to reduce unnecessary ER utilization among persons living in homelessness, resulting in decreased healthcare spending and improved patient outcomes.

Purpose: The aim of this study is to evaluate the outcomes of a student-led integrated free clinic housed within a local faith-based organization caring for clients living in homelessness. We evaluated both emergency room (ER) utilization rates, reason, and disposition of the visits. The student-led clinic is run through the School of Nursing and consists of an interprofessional staff of nurse practitioners, social workers, and graduate and undergraduate students who minimize access barriers by providing both primary and acute care services, including infectious disease screening and treatment and harm reduction.

Methods: A non-experimental causal-comparative retrospective design was used to analyze data from the region’s hospital system’s five emergency departments. A total of 252 unique individuals were identified and evaluated on ER utilization and most occurring diagnoses. Participants were identified as unhoused with an identified address from the clinic. Difference in ER visits on days that the clinic was compared to non-operating days. Descriptive data related to admission diagnosis and disposition of the visit were collected. Outcomes were measured for the year 2022.

Outcomes: The study demonstrated that although the participants who attended the student-led free clinic in 2022 had higher ER utilization rates, 83.8% of all ER visits occurred when the clinic was closed, indicating a need to increase operating hours. Out of all 734 visits, the researcher concluded that 548 could have been seen in the clinic. Mental and behavioral health diagnoses, acute illnesses, injuries, wounds, and dental complaints were prevalent, signifying a demand for the implementation of mental health, dental, and wound care programs in the clinic.

Keywords

student-led free clinic, patients living in homelessness, ER utilization

Comments

References

Garrett, D. G. (2012). The business case for ending homelessness: Having a home improves health, reduces healthcare utilization and costs. American Health & Drug Benefits, 5(1), 17-19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046466/

Moore, B. J., & Liang, L. (2020). Costs of emergency department visits in the United States, 2017 (Statistical Brief No. 268). Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK566654/

Salhi, B. A., White, M. H., Pitts, S. R., & Wright, D. W. (2018). Homeless and emergency medicine: A review of the literature. Academic Emergency Medicine, 25(5), 577-593. https://doi.org/10.1111/acem.13358

Vohra, N., Paudyal, V., & Price, M. J. (2022). Homelessness and the use of emergency department as a source of healthcare: A systematic review. International Journal of Emergency Medicine, 15(32). http://doi.org/10.1186/s12245-022-00435-3

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Emergency Room Utilization Rates Among Unhoused Patients Receiving Care at a Student-led Free Clinic

Purpose statement: The purpose of this activity is to allow the learner to recognize the impact of a student-led clinic aimed at caring for those living in homelessness by providing accessible primary care and minimizing barriers to reduce avoidable emergency room utilization.

Objectives:

  1. At the end of the presentation, learners will be able to discuss and demonstrate knowledge of outcomes related to emergency room visits when student-led clinics are implemented in their region.
  2. To identify the most common reasons persons living in homelessness present to the emergency room to expand services in future practice.

Background: Studies have determined that unhoused patients have higher rates of emergency room (ER) utilization and are more likely to have repeated visits, with three-fourths of the visits categorized as inappropriate or avoidable (Salhi et al., 2017). In 2017 ER visits totaled over 76 billion (Moore & Liang, 2020). The average person living in homelessness visits the ER a minimum of five times a year, costing a minimum of 18,000 dollars (Garrett, 2012). Unhoused people face many barriers to accessing quality care and suffer from higher morbidity and mortality rates due to uncontrolled chronic conditions, untreated mental health, and unmet social needs. A homeless individual's life expectancy is less than 50 years old (Vohra et al., 2022). Multiple studies indicate that student-led free clinics are positioned to reduce unnecessary ER utilization among persons living in homelessness, resulting in decreased healthcare spending and improved patient outcomes.

Purpose: The aim of this study is to evaluate the outcomes of a student-led integrated free clinic housed within a local faith-based organization caring for clients living in homelessness. We evaluated both emergency room (ER) utilization rates, reason, and disposition of the visits. The student-led clinic is run through the School of Nursing and consists of an interprofessional staff of nurse practitioners, social workers, and graduate and undergraduate students who minimize access barriers by providing both primary and acute care services, including infectious disease screening and treatment and harm reduction.

Methods: A non-experimental causal-comparative retrospective design was used to analyze data from the region’s hospital system’s five emergency departments. A total of 252 unique individuals were identified and evaluated on ER utilization and most occurring diagnoses. Participants were identified as unhoused with an identified address from the clinic. Difference in ER visits on days that the clinic was compared to non-operating days. Descriptive data related to admission diagnosis and disposition of the visit were collected. Outcomes were measured for the year 2022.

Outcomes: The study demonstrated that although the participants who attended the student-led free clinic in 2022 had higher ER utilization rates, 83.8% of all ER visits occurred when the clinic was closed, indicating a need to increase operating hours. Out of all 734 visits, the researcher concluded that 548 could have been seen in the clinic. Mental and behavioral health diagnoses, acute illnesses, injuries, wounds, and dental complaints were prevalent, signifying a demand for the implementation of mental health, dental, and wound care programs in the clinic.