Homelessness and Emergency Medicine: A Review of the Literature

Abstract

Objectives

We aimed to synthesize the available evidence on the demographics, prevalence, and clinical characteristics, and evidence-based management of homeless persons in the Emergency Department (ED). Where appropriate, we highlight knowledge gaps and suggest directions for future research.

Methods

We conducted a systematic literature search following databases: PubMed, Ovid, and Google Scholar for articles published between January 1, 1990 and December 31, 2016. We supplemented this search by cross-referencing bibliographies of the retrieved publications. Peer-reviewed studies written in English and conducted in the United States (US) that examined homelessness within the ED setting were included. We used a qualitative approach to synthesize the existing literature.

Results

Twenty-eight studies were identified that met the inclusion criteria. Based on our study objectives and the available literature, we grouped articles examining homeless populations in the ED into four broad categories: 1) Prevalence and socio-demographic characteristics of homeless ED visits; 2) ED utilization by homeless adults; 3) Clinical characteristics of homeless ED visits; 4) Medical education and evidence-based management of homeless ED patients.

Conclusion

Homelessness may be under-recognized in the ED setting. Homeless ED patients have distinct care needs and patterns of ED utilization that are unmet by the current disease-oriented and episodic models of emergency medicine. More research is needed to determine the prevalence and characteristics of homelessness in the ED and to develop evidence-based treatment strategies in caring for this vulnerable population.

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