Prevalence of homelessness among hospitalized patients: A point-in-time survey.

Although homelessness is associated with increased acute healthcare utilization and poorer health outcomes, the prevalence of homelessness and housing insecurity in hospitalized patients is poorly characterized. We conducted an in-person survey to determine the prevalence of housing insecurity and homelessness among hospitalized patients at two hospitals in metropolitan Denver in conjunction with the Housing and Urban Development point-in-time count on January 24, 2022. Of the 271 surveyed patients, 79 (29.2%) reported experiencing either housing insecurity (17.3%) or homelessness (11.8%). Of those experiencing housing insecurity or homelessness, 69.6% reported chronic health conditions, 55.7% reported multiple hospitalizations in the preceding year, 38% reported mental health concerns and 39.2% reported substance use. The prevalence of homelessness among a hospitalized patient population was over 20-fold higher than community prevalence estimates. Housing insecurity also impacted a substantial proportion of hospitalized patients and was associated with high rates of co-morbid conditions.

Hospitalization and Housing: A Qualitative Study Exploring the Perspectives of Hospitalized Patients Experiencing Housing Insecurity.

Although housing insecurity has clear negative impacts on health, little is known about how it impacts patients' experience of hospitalization. In this qualitative study, we interviewed 22 hospitalized patients experiencing housing insecurity. The following three major themes emerged: 1) adverse social and environmental factors directly contribute to hospitalization, 2) lack of tailored care during hospitalization leaves patients unprepared for discharge, and 3) patients have difficulty recuperating after a hospital stay, leading to the risk of rehospitalization. Within these themes, participants described the roles of extreme physical and psychological hardship, chaotic interpersonal relationships, substance use, and stigma affecting participants' experiences before, during, and following hospitalization. Our results, based directly on the patient experience, suggest a need for hospital systems to invest in universal in-hospital screening for housing insecurity, incorporation of trauma-informed care, and robust partnerships with community organizations. Future research should explore the feasibility and impact of these interventions.

Pain Control Disparities in Acute Pancreatitis.

Background and objective Patient treatments and outcomes have historically differed based on age, sex, race/ethnicity, and social factors, and there is a growing awareness that such disparities still exist. While prior studies have found that patients belonging to minority groups have their pain undertreated, few studies have evaluated pain control based on age, sex, body mass index (BMI), or presence of a substance use disorder (SUD). The studies that do exist have inconsistent results. This study aimed to evaluate pain control in patients admitted to a Denver academic safety net hospital for acute pancreatitis. Pancreatitis is an inherently painful condition involving pancreatic inflammation and for which adequate pain control is a cornerstone of treatment; this makes it an ideal disease state for an exploratory analysis into the experience of pain within different patient groups. Methods This was a retrospective cohort study of patients treated at the Denver Health Medical Center from January 1, 2017, through December 31, 2019, for acute pancreatitis; 659 patients met the inclusion criteria and were included in the study. Pain control during the first 24 hours of hospital admission was analyzed by comparing controlled vs. uncontrolled reports of pain and mean pain scores. Patients were stratified by age, sex, self-reported race/ethnicity, BMI, and presence of SUD at the time of admission. Achievement of "controlled pain," as defined by a pain score below the patient's stated functional pain goal, was then analyzed. Chi-squared analysis was employed to look into differences within and between groups. Additionally, a t-test was used to compare mean pain scores between groups with controlled and uncontrolled pain. Results A statistically significant difference in pain control was found when stratified by age or the presence of SUD (p<0.001). Within these groups, 39% of those aged 18-40 years achieved pain control, compared with 49% of those aged 41-64 years and 66% of those aged 65 years and older. Among those with active SUD, only 41% were able to achieve pain control compared with 58% of those without SUD. Among those who achieved pain control, the average mean pain score was 5, which decreased to 4 within 24 hours. Among those who did not achieve pain control, the average mean pain score was 7, which remained at 7 at 24 hours (p<0.001). Conclusions We did not find significant differences in the ability to achieve tolerable pain control based on sex or BMI. We were unable to appropriately analyze differences based on race/ethnicity due to an inability to differentiate between White Hispanic and White non-Hispanic populations within Epic. However, we did find significantly poorer pain control in younger patients and those with an active SUD.

Feasibility and Impact of Trauma-Informed Care Training in Internal Medicine Residency: A Pilot Study.

INTRODUCTION: Mounting evidence indicates that early life trauma is highly prevalent and associated with adverse health outcomes later in life. However, primary care providers report lacking the training to effectively address trauma encountered in daily practice. There is a paucity of research describing the implementation and evaluation of trauma-informed care (TIC) curricula within Graduate Medical Education. METHODS: We piloted a three-hour TIC workshop facilitated by a community-based psychologist expert to assess the feasibility and impact of TIC training on Internal Medicine (IM) residents' knowledge, attitudes and skills related to TIC. Participants were a subset of IM residents in a health-equity-focused curricular pathway in the University of Colorado IM Residency. Residents completed anonymous surveys one week before and after the workshop, and a final survey 10 weeks later. Residents who did not participate in the workshop completed a similar baseline survey (control group). Data were analyzed using matched pair T-tests. RESULTS: Fourteen of 20 residents (70%) who participated in the pilot workshop completed the initial survey. Of these, 10 (71%) completed the first post-workshop survey, and seven (50%) completed the final survey. We observed significant improvements in residents' self-reported knowledge, attitudes and skills related to TIC. The majority of residents in the control group reported a desire for TIC training. CONCLUSIONS: TIC is an important curricular gap in IM training. A single, brief TIC workshop was feasible and was associated with improved self-reported knowledge, attitudes and skills among IM residents.

Improving end-of-rotation transitions of care among ICU patients.

BACKGROUND: Hospitalised patients whose inpatient teams rotate off service experience increased mortality related to end-of-rotation care transitions, yet standardised handoff practices are lacking. OBJECTIVE: Develop and implement a multidisciplinary patient-centred handoff intervention to improve outcomes for patients who are critically ill during end-of-rotation transitions. DESIGN, SETTING AND PARTICIPANTS: Single-centre, controlled pilot study of medical intensive care unit (ICU) patients whose resident team was undergoing end-of-rotation transition at a university hospital from June 2017 to February 2018. INTERVENTION: A 4-item intervention was implemented over two study periods. Intervention 1 included: (1) in-person bedside handoff between teams rotating off and on service, (2) handoff checklist, (3) nursing involvement in handoff, and (4) 30 min education session. Intervention 2 included the additional option to conduct bedside handoff via videoconferencing. MAIN OUTCOME MEASURES: Implementation was measured by repeated clinician surveys and direct observation. Patient outcomes included length of stay (LOS; ICU and hospital) and mortality (ICU, hospital and 30 days). Clinician perceptions were modelled over time using per cent positive responses in logistic regression. Patient outcomes were compared with matched control 'transition' patients from 1 year prior to implementation of the intervention. RESULTS: Among 270 transition patients, 46.3% were female with a mean age of 55.9 years. Mechanical ventilation (64.1%) and in-hospital death (27.6%) rates were prevalent. Despite high implementation rates-handoff participation (93.8%), checklist utilisation (75.0%), videoconferencing (62.5%), nursing involvement (75.0%)-the intervention did not significantly improve LOS or mortality. Multidisciplinary survey data revealed significant improvement in acceptability by nursing staff, while satisfaction significantly declined for resident physicians. CONCLUSIONS: In this controlled pilot study, a structured ICU end-of-rotation care transition strategy was feasible to implement with high fidelity. While mortality and LOS were not affected in a pilot study with limited power, the pragmatic strategy of this intervention holds promise for future trials.