Eakin McKenzie, Singleterry Vania, Wang Ewen, Brown Ian, Saynina Olga, Walker Rebecca
Emergency Medicine, Emory University School of Medicine, Atlanta, USA.
Pediatric Emergency Medicine, University of California San Francisco, Oakland, USA.
Cureus. 2023 Feb 27;15(2):e35534. doi: 10.7759/cureus.35534. eCollection 2023 Feb.
Introduction California State Bill 1152 (SB1152) mandated all non-state-operated hospitals meet specific criteria when discharging patients identified as experiencing homelessness. Little is known about SB1152's effect on hospitals or compliance statewide. We studied the implementation of SB1152 in our emergency department (ED). Methods We analyzed our suburban academic ED's institutional electronic medical record for one year before (July 1, 2018-June 20, 2019) and one year after (July 1, 2019-June 30, 2020) implementation of SB1152. We identified individuals by lack of address during registration, International Classification of Diseases, Tenth Revision (ICD-10) code of homelessness, and/or the presence of an SB1152 discharge checklist. Demographics, clinical information, and repeat visit data were collected. Results ED volumes were constant during the pre- and post-SB1152 periods (approximately 75,000 annually); however, ED visits by people experiencing homelessness more than doubled (630 (0.8%) to 1530 (2.1%) in the pre- and post-implementation periods. Age and sex distributions were similar with approximately 80% of patients aged 31-65 years and less than 1% under 18. Visits by females comprised less than 30% of the population. Visits by people of the White race decreased from 50% to 40% pre- and post-SB1152. Visits by people of the Black, Asian, and Hispanic races experiencing homelessness increased by 18% to 25%, 1% to 4%, and 19% to 21%, respectively. Acuity was unchanged with 50% of visits classified as "urgent." Discharges increased from 73% to 81% and admissions halved from 18% to 9%. Visits by patients with only one ED visit decreased (28% to 22%); those with four or more visits increased (46% to 56%). The most common primary diagnoses pre- and post-SB1162 were alcohol use (6.8% and 9.3%, respectively), chest pain (3.3% and 4.5%, respectively), convulsions (3.0%, and 2.46%, respectively), and limb pain (2.3% and 2.3%, respectively). The primary diagnosis of suicidal ideation doubled from the pre- to post-implementation periods (1.3% to 2.2%, respectively). Checklists were completed for 92% of identified patients discharged from the ED. Conclusion Implementation of SB1152 in our ED resulted in identifying an increased number of persons experiencing homelessness. We identified opportunities for further improvement since pediatric patients were missed. Further analysis is warranted, especially with the coronavirus disease 2019 (COVID-19) pandemic, which has significantly affected healthcare-seeking behavior in EDs.
引言 加利福尼亚州第1152号法案（SB1152）要求所有非州立运营的医院在让被认定为无家可归的患者出院时要符合特定标准。关于SB1152对医院的影响或全州范围内的合规情况，人们知之甚少。我们研究了SB1152在我们急诊科（ED）的实施情况。方法 我们分析了SB1152实施前一年（2018年7月1日至2019年6月20日）和实施后一年（2019年7月1日至2020年6月30日）我们郊区学术性急诊科的机构电子病历。我们通过登记时缺少地址、国际疾病分类第十版（ICD - 10）的无家可归代码和/或存在SB1152出院检查表来识别个体。收集了人口统计学、临床信息和复诊数据。结果 在SB1152实施前后，急诊科就诊量保持稳定（每年约75,000人次）；然而，无家可归者的急诊科就诊量增加了一倍多（实施前为630人次（0.8%），实施后为1530人次（2.1%））。年龄和性别分布相似，约80%的患者年龄在31 - 65岁之间，18岁以下患者不到1%。女性就诊者占比不到30%。白种人就诊者在SB1152实施前后从50%降至40%。无家可归的黑种人、亚裔和西班牙裔就诊者分别增加了18%至25%、1%至4%和19%至21%。病情严重程度不变，50%的就诊被归类为“紧急”。出院率从73%升至81%，住院率从18%减半至9%。仅就诊一次的患者就诊量减少（从28%降至22%）；就诊四次或更多次的患者就诊量增加（从46%升至56%）。SB1152实施前后最常见的主要诊断是酒精使用（分别为6.8%和9.3%）、胸痛（分别为3.3%和4.5%）、抽搐（分别为3.0%和2.46%）以及肢体疼痛（分别为2.3%和2.3%）。自杀意念的主要诊断从实施前到实施后增加了一倍（分别为1.3%和2.2%）。92%从急诊科出院的已识别患者完成了检查表。结论 SB1152在我们急诊科的实施导致识别出更多无家可归者。由于儿科患者被遗漏，我们发现了进一步改进的机会。有必要进行进一步分析，特别是考虑到2019冠状病毒病（COVID - 19）大流行对急诊科就医行为产生了重大影响。
