The St Thomas’ Hospital Emergency Department Homeless Health Initiative: improving the quality, safety and equity of healthcare provided for homeless patients attending the ED

• Published in: BMJ open quality 2020-02, Vol.9 (1), p.e000820
• Main Authors: Gallaher, Charles, Herrmann, Simone, Hunter, Laura, Wilkins, Alex
• Format: Article
• Language: English
• Subjects: Alcohol; Attitude of Health Personnel; emergency department; Emergency medical care; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - standards; Emergency Service, Hospital - statistics & numerical data; Female; harm reduction; Health Equity - standards; Health Equity - statistics & numerical data; healthcare quality improvement; Homeless people; Hospitals; Hospitals - standards; Hospitals - statistics & numerical data; Hostels; Humans; Ill-Housed Persons - statistics & numerical data; London; Male; Mental health; Middle Aged; Oral hygiene; patient discharge; patient safety; Patient Safety - standards; Patient Safety - statistics & numerical data; Population; Primary care; Public health; Quality control; Quality Improvement; Quality Improvement Report; Social Work - instrumentation; Social Work - methods
• ISSN: 2399-6641; 2399-6641
• DOI: 10.1136/bmjoq-2019-000820

We carried out a quality improvement (QI) project (QIP), aiming to improve the quality, safety and equity of healthcare provided for homeless patients attending the emergency department (ED). We used QI methodology to identify areas for improvement, and introduced and modified interventions over four Plan, Do, Study, Act cycles. We launched a departmental ‘Homeless Health Initiative’ (HHI), the chief intervention being the provision of ‘Homeless Health Boxes’ in the ED, which contained a ‘Safe Discharge Checklist for Homeless Patients’, maps to specialist homeless general practitioner surgeries and homeless day centres, information on other inclusion health services, copies of a local rough sleepers’ magazine and oral hygiene supplies. Voluntary Homeless Link Nurses and a number of informal ‘Homeless Health Champions’ were appointed. The HHI was embedded in departmental awareness through regular presentations to staff and incorporation into the induction programme for new doctors. Staff satisfaction, in terms of how satisfied staff members were with the care they were able to provide for homeless patients in the ED on a 0–10 scale, improved modestly over the course of the QIP from median 6/10 to median 7/10. The number of staff who were severely dissatisfied with the care they were able to provide for homeless patients improved more markedly: first quartile staff satisfaction improved from 3.875/10 to 6.125/10. Staff compliance with the checklist was poor, with full compliance observed in only 15% of cases by the end of the QIP. An HHI is a cheap and worthwhile QI project, with the potential to significantly improve the quality, safety and equity of healthcare provided for homeless patients, while improving staff satisfaction concurrently. Similar initiatives should be considered in any ED which sees a significant number of homeless patients.