Managing "socially admitted" patients in hospital: a qualitative study of health care providers' perceptions

• Published in: Canadian Medical Association journal (CMAJ) 2024-05, Vol.196 (17), p.E580-E590
• Main Authors: Mah, Jasmine C, Stilwell, Christie, Kubiseski, Madeline, Arora, Gaurav, Nicholls, Karen, Khan, Sheliza, Veinot, Jonathan, Eum, Lucy, Freter, Susan, Koller, Katalin, von Maltzahn, Maia, Rockwood, Kenneth, Searle, Samuel D, Andrew, Melissa K, Marshall, Emily Gard
• Format: Article
• Language: English
• Subjects: Adult; Attitude of Health Personnel; Care and treatment; Data analysis; Data collection; Departments; Discharge planning; Disease susceptibility; Emergency medical care; Emergency Service, Hospital; Female; Grounded Theory; Health care; Health care industry; Health Personnel - psychology; Health sciences; Hospital patients; Hospitals; Humans; Interviews; Interviews as Topic; Male; Management; Medical care; Medical research; Medicine; Medicine, Experimental; Middle Aged; Nova Scotia; Nurses; Nursing; Patients; Qualitative Research; Quality management; Social workers; Terminology; Vulnerable Populations - psychology; Well being
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.231430

Emergency departments are a last resort for some socially vulnerable patients without an acute medical illness (colloquially known as "socially admitted" patients), resulting in their occupation of hospital beds typically designated for patients requiring acute medical care. In this study, we aimed to explore the perceptions of health care providers regarding patients admitted as "social admissions." This qualitative study was informed by grounded theory and involved semistructured interviews at a Nova Scotia tertiary care centre. From October 2022 to July 2023, we interviewed eligible participants, including any health care clinician or administrator who worked directly with "socially admitted" patients. Virtual or in-person individual interviews were audio-recorded and transcribed, then independently and iteratively coded. We mapped themes on the 5 domains of the Quintuple Aim conceptual framework. We interviewed 20 nurses, physicians, administrators, and social workers. Most identified as female ( = 11) and White ( = 13), and were in their mid to late career ( = 13). We categorized 9 themes into 5 domains: patient experience (patient description, provision of care); care team well-being (moral distress, hierarchy of care); health equity (stigma and missed opportunities, prejudices); cost of care (wait-lists and scarcity of alternatives); and population health (factors leading to vulnerability, system changes). Participants described experiences caring for "socially admitted" patients, perceptions and assumptions underlying "social" presentations, system barriers to care delivery, and suggestions of potential solutions. Health care providers viewed "socially admitted" patients as needing enhanced care but identified individual, institutional, and system challenges that impeded its realization. Examining perceptions of the people who care for "socially admitted" patients offers insights to guide clinicians and policy-makers in caring for socially vulnerable patients.