Assessing Patients' Social Needs While Delivering Emergency Nursing Care: A Pilot Evaluation to Inform the Use of a Screening Tool

With recent healthcare policy changes, including the creation of the accountable care organizations, screening for social risks such as food and housing insecurity has become increasingly common in the healthcare system. However, little is known about the social need screening practices in emergency departments (ED) (Ciccolo et al., 2020). A growing body of research links social and behavioral factors, including low income, low levels of education, lack of exercise, and stress, to the onset and progression of diseases (Adler et al., 2015). In a typical modern ED, homelessness, substance abuse, and violence are as common and pervasive as coronary artery disease, diabetes and hypertension. In this environment, where does the responsibility of an ED provider begin and end? This question is as relevant to our daily practice as any clinical decision made by healthcare providers (Anderson et al ., 2016). The role of the hospital ED is central to community health as an access point to the medical system, regardless of patients' ability to pay. Walk through the halls of any ED, and social determinantsof health can be seen and felt at all hours of the day. The ED is often where patients with many essential social and medical needs seek care (Anderson et al ., 2016). Social determinants of health (SDoH) can affect health and outcomes after a hospital visit, but evidence-based screening or assessment of SDoH during an ED visit does not appear to be a standard of care. Despite the high prevalence of health-related social needs among ED patients, screening for SDoH is more likely to occur in outpatient settings rather than the ED. A recent survey of screening in primary care physician practices found that 16% of practices performed screenings for five health-related social needs such as food insecurity/hunger, housing instability/homelessness, trouble paying utilities, difficulty obtaining transportation, and experience with interpersonal violence (Fraze et al ., 2019). Although there is a strong interest among ED providers to address health-related social needs, many providers believe themselves unable to act because of the lack of time and knowledge (Samuels et al., 2021). Multiple studies have shown that screening for social needs in health care settings is acceptable by patients; however, EDs still face significant challenges in addressing the non-medical but health-influencing needs of their patients. Byhoff, Marchis, Hessler et al., conducted a study to better understand patient perspectives on social risk screening across different health care settings. A mixed-methods study was used with participants to complete a 10-item social risk screening tool. It included questions exploring participants' reactions to social risk screening, screening acceptability, screen administration preferences, prior social risk screening experiences, and social needs assistance expectations. Many interviewees described "relief" or "gratitude" after completing the social risk assessment, noting that the questions were important to ask.