Homelessness in the UK: How to Improve Accident and Emergency Discharge

Abstract

Introduction (Aims & Problem Statement)

From 2010 to 2018, admissions of homeless patients into accident and emergency (A&E) services have trebled with readmission rates almost 2.5 times higher than housed patients. 

Appropriate discharge of homeless patients is often inadequate with more than 70% of them being discharged back onto the street, without their housing or underlying health problems being addressed. With timely and effective healthcare, one in three homeless deaths can be avoided.

Our white paper aims to identify problems associated with current homeless hospital discharge (HHD) protocols in order to improve homeless discharge coordination.

Findings

Despite governmental interventions, including the Homeless Reduction Act 2017, which states that healthcare professionals should refer homeless patients to local authority, implementation is far from widespread. 

Locally trialled quality improvement projects (QIPs) carried out throughout hospitals in the UK revealed that there was:

• Poor medical staff awareness and compliance with the HHD protocol due to lack of understanding and excessive workload


• Poor design of the HHD protocol which is not appropriate for A&E settings


• A lack of pathways including non-UK citizens in HHD protocol

Proposed Solutions

We propose several solutions to tackle the stated problems:

1. Implement a dedicated homeless discharge team to address housing needs, community health service provisions and non-UK citizen support


2. Implement a simplified HHD protocol for A&E departments in the form of a checklist as a referral tool to a dedicated homeless discharge team


3. Include mandatory training to inform A&E staff on the use of HHD protocol and raise awareness around the issues homeless patients face

Conclusion

The introduction of a standardised HHD protocol and homeless discharge team will facilitate an effective discharge process for homeless patients, whilst mandatory training will improve staff compliance. Overall, through the implementation of our solutions we aim to improve homeless discharge, reduce readmissions, and improve trauma care for homeless patients.