AEM Early Access 30: A Qualitative Study of the Newly Homeless ED Patients

Welcome to the twenty-ninth episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to an recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

Find this podcast series on iTunes here.

DISCUSSING (CLICK ON TITLE FOR FULL TEXT, OPEN ACCESS THROUGH SEPTEMBER 30):

“It wasn’t just one thing”: A qualitative study of newly homeless emergency department patients.” Kelly M. Doran, MD, MHS, Ziwei Ran, MSW, Donna Castelblanco, MBE, Donna Shelley, MD, MPH, and Deborah K. Padgett, MA, PhD, MPH

LISTEN NOW: INTERVIEW WITH FIRST AUTHOR KELLY DORAN

Kelly Doran, MD, MHS

Assistant Professor

Ronald O. Perelman Department of Emergency Medicine and Department of Population Health, NYU School of Medicine

ABSTRACT

Objectives

Emergency departments (EDs) frequently care for patients who are homeless or unstably housed. One promising approach taken by the homeless services system is to provide interventions that attempt to prevent homelessness before it occurs. Experts have suggested that health care settings may be ideal locations to identify and intervene with patients at risk for homelessness, yet little is known even about the basic characteristics of patients who might benefit from such interventions.

Methods

We conducted in‐depth, one‐on‐one qualitative interviews with ED patients who had become homeless within the past 6 months. Using a semistructured interview guide, we asked patients about their pathways into homelessness and what might have prevented them from becoming homeless. Interviews were digitally recorded and professionally transcribed. Transcripts were coded line by line by multiple investigators who then met as a group to discuss and refine codes in an iterative fashion.

Results

Interviews were completed with 31 patients. Mean interview length was 42 minutes. Four main themes emerged: 1) unique stories yet common social and health contributors to homelessness, 2) personal agency versus larger structural forces, 3) limitations in help from family or friends, and 4) homelessness was not expected.

Conclusions

These findings demonstrate gaps in current homeless prevention services and can help inform future interventions for unstably housed and homeless ED patients. More immediately, the findings provide rich, unique context to the lives of a vulnerable patient population commonly seen in EDs.