A national cross-sectional survey study led by Dr. Melanie Molina, MD, MAS, an assistant professor of Emergency Medicine at UCSF, found that less than one-third of United States emergency departments (EDs) screened for adverse social determinants of health (SDOH), and one-fifth lacked policies requiring a response to positive screens, despite the high prevalence of unmet social needs in ED populations. Findings were published in JAMA Network Open on April 23.
Among 232 surveyed EDs, only 28.4% had written policies to screen for at least one adverse SDOH, defined as housing instability, food insecurity, transportation difficulties, or trouble paying utilities. In contrast, 93.1% reported screening for other requirement-driven risk factors, including intimate partner violence, substance use, and mental health conditions.
Of EDs conducting any type of screening, 81.6% had policies in place to guide responses, primarily through social work consultations (78.2%), standardized information sheets (43.0%), and individualized resource information (12.9%). However, only 20.5% had an ED-based social worker, and just 23.4% had social work services available 24/7. No significant associations were found between ED characteristics (urbanicity, practice setting, or volume) and the presence of adverse SDOH screening or response policies.
The study highlights a substantial gap in addressing adverse SDOH in EDs and calls for expanded screening efforts supported by improved infrastructure and resources. “Next steps include working to bridge the gap between identifying adverse SDOH and delivering timely responses in ED settings without overburdening staff and physicians,” the authors wrote.
Featured image: Dr. Molina