Table 2 Themes and illustrative quotes about health-related social needs information availability, collection, and use in the emergency department setting
Theme | Description & representative quotes | |
|---|---|---|
Availability | Health-related social needs information accessible during emergency department encounters | |
ED provider | “[Asking about HRSNs] is not something that is like normal practice, because it’s hard to do when you don’t have a dedicated screener. So in the hubbub of what is the ED, …if we have to get them home or we have to figure out prescriptions, right, like the if the patient offers up the information, like ‘I can’t afford my prescriptions’ or ‘I don’t have health insurance,’ or ‘I don’t have a way of getting back home’…that’s kind of when those things come out.” (#8) | |
ED staff | “On our [EHR] screen we can see if they’re in any financial debt in the hospital system… We can access it, but you have to know where to find it.” (#9) | |
Sometimes in the [EHR] you will have like documentation on a patient’s background or history, but a lot of times that leaves you to kind of making judgement on them. Whether they do have insurance. Whether they don’t have insurance. Whether they suffer from homelessness. It’s not always readily available for you.” (#15) | ||
Patient | “I don’t know that I wanna talk about my finances with somebody in the emergency room.” (#19) | |
Collection | How information is obtained | |
ED provider | “Mostly, I just ask them.” (#5) | |
“Usually it comes up because the patient will say something. Or nursing will come to us and say, ‘Oh, by the way, did you know that he doesn’t have a place to go tonight?’…It’s almost a last-minute, almost like an afterthought, sometimes.” (#2) | ||
ED staff | “If I know they came in via an ambulance I kind of start talking then like, ‘If you get discharged how are you going to get home?’ (#12) | |
“One of our populations, a lot of them are scared to tell us what’s really going on, where they actually live, who they, who’s actually in the home, and what their needs really are because they’re scared of us reporting it to the government. We have to let them know, ‘You know, we’re here to care for your medical,’ and then that’s when they start disclosing. So, that’s a challenge.” (#14) | ||
Patient | “It feel like it’s more private if I’m writing on the paper.” (#20) | |
Use | How information should be used in care delivery | |
ED provider | “Addressing some of those is not really within our ability.” (#5) | |
“There are a lot of social determinants and each patient has their own, kind of conglomeration of factors…I try to tailor to be patient-specific on what I perceive their needs to be in that moment.” ( #7) | ||
ED staff | “I think social work does a lot. We get a lot of homeless…Sometimes it’s hard to get them coverage because there’s no mailing address. So then we just use [the ED] as the mailing address for the homeless population. So social work do most of the helping them as far as food, as far as, you know, if they need – on the ED if they need transportation, they’ll call them a cab. And they do things like that.” (#11) | |
Patient | “In an ideal world they would connect you with a social worker who would be able to assist you with those things with resources.” (#18) |