Screening for health-related social needs in the emergency department: Adaptability and fidelity during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: We sought to evaluate a screening and referral program for health-related social needs (HRSN) in our ED. Our goals were to (1) quantify successful screenings prior to and during the initial peak of the pandemic, and (2) describe the HRSNs identified. METHODS: We performed an observational analysis of ED-based screening for HRSN in Medicare and Medicaid patients at our large urban safety-net hospital. Screening was performed by patient navigators utilizing the ten question, validated Accountable Health Communities (AHC) Screening Tool, which screens for food insecurity, housing instability, transportation needs and utility assistance and interpersonal safety. Patients who screened positive for HRSN were provided with handouts listing community resources. For patients with two or more self-reported ED visits in the last 12 months and any identified HRSN, ongoing navigation after discharge was provided utilizing community resource referrals. During the pre-pandemic period from November 1, 2019 - January 31, 2020, screening occurred in-person. Screening during the pandemic from March 1, 2020 - May 31, 2020 occurred remotely via telephone. Descriptive statistics including frequency rates and percentages were calculated. Successful screening was defined as completing the screening survey with a navigator and being triaged to either no assistance, resource handouts, or navigation services. RESULTS: Among the adult and pediatric patients screened for HRSN, 158 (16%) qualified for community resource handouts and 440 (44.4%) qualified for patient navigator services. The proportion of patients receiving both resources and care navigation remained similar in the pre- and post-periods of the study, at 227 (45%) and 213 (43.9%) respectively. However, the proportion of ED patients with a HRSN need doubled from 56 (11.1%) in the pre-period to 102 (21%) in the post-period. Food insecurity was the most identified HRSN in both the pre-pandemic period (27.3%) and during the pandemic (35.8%). CONCLUSION: We found that remote HRSN screening for ED patients during the COVID-19 pandemic resulted in similar proportions of successfully completed screenings compared to pre-pandemic efforts. This demonstrates the feasibility of utilizing alternative methods of screening and referral to community resources from the ED, which could facilitate this type of intervention in other EDs. During the pandemic HRSN increased, likely reflecting the economic impact of the pandemic.

Door-to-Imaging Time for Acute Stroke Patients Is Adversely Affected by Emergency Department Crowding.

BACKGROUND AND PURPOSE: National guidelines call for door-to-imaging time (DIT) within 25 minutes for suspected acute stroke patients. Studies examining factors that affect DIT have focused primarily on stroke-specific care processes and patient-specific factors. We hypothesized that emergency department (ED) crowding is associated with longer DIT. METHODS: We conducted a retrospective investigation of 1 year of consecutive patients in our prospective Code Stroke registry, which included all ED stroke team activations. The registry and electronic health records were abstracted for 27 potential predictors of DIT, including patient, stroke care process, and ED operational factors. We fit a multivariate logistic regression model and calculated odds ratios and 95% confidence intervals. Second, we constructed a random forest recursive partitioning model to cross-validate our findings and explore the proportional importance of each category of predictor. Our primary outcome was the binary variable of DIT within the 25-minute goal. RESULTS: A total of 463 patients met inclusion criteria. In the regression model, ED occupancy rate emerged as a predictor of DIT, with odds ratio of 0.83 (95% confidence interval, 0.75-0.91) of DIT within 25 minutes per 10% absolute increase in ED occupancy rate. The secondary analysis estimated that ED operational factors accounted for nearly 14% of the algorithm's prediction of DIT. CONCLUSIONS: ED crowding is associated with reduced odds of meeting DIT goals for acute stroke. In addition to improving stroke-specific processes of care, efforts to reduce ED overcrowding should be considered central to optimizing the timeliness of acute stroke care.