Emergency Department Intervention and Referral for Homeless Individuals: Reducing Revisits

Background This study evaluated the effectiveness of an emergency department (ED)-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) program for homeless individuals in reducing ED revisits and explored factors associated with recurrent ED utilization. Methods We performed a retrospective observational study of homeless patients who visited the ED of a public hospital in Seoul, South Korea, between January 2015 and December 2022. The program included screening, brief interventions, and referrals by ED-based social workers to services addressing social determinants of health (SDoH) such as housing and financial insecurity. The primary outcomes were ED revisits within 48 hours, 7 days, and 30 days after discharge. Multivariable logistic regression identified factors associated with revisits. Results Of 3,179 homeless patients, 1,281 (40.3%) were screened, 979 (30.8%) received brief interventions, and 556 (18.2%) were referred to services addressing SDoH. Among 2,394 discharged patients, those referred to services had significantly fewer ED revisits at 48 hours (13.8% vs. 23.8%; P = 0.009) and 7 days (28.3% vs. 41.5%; P = 0.003), but not at 30 days (46.2% vs. 54.6%; P = 0.068). Recent ED use was the strongest factor associated with revisits across all time points. Conclusion An ED-based SBIRT program was associated with reduced short-term ED revisits among homeless individuals, particularly those with prior ED visits. These findings highlight the potential of targeted social interventions within emergency care to improve outcomes for underserved populations.