• Jasmine C Mah, Christie Stilwell, Madeline Kubiseski, Gaurav Arora, Karen Nicholls, Sheliza Khan, Jonathan Veinot, Lucy Eum, Susan Freter, Katalin Koller, Maia von Maltzahn, Kenneth Rockwood, Samuel D Searle, Melissa K Andrew, and Emily Gard Marshall.
• Department of Medicine (Mah, Eum), and Faculties of Health (Stilwell) and Medicine (Kubiseski, Arora), Dalhousie University; Frailty and Elder Care Network (Nicholls), Care Coordination Centre (Khan), and Queen Elizabeth II Halifax Infirmary Emergency Department (Veinot), Nova Scotia Health; Division of Geriatric Medicine (Freter, Koller, von Maltzahn, Rockwood, Searle, Andrew), Department of Medicine, and Department of Family Medicine Primary Care Research Unit (Marshall), Dalhousie University, Halifax, NS Jmah@dal.ca.
• CMAJ. 2024 May 5; 196 (17): E580E590E580-E590.

BackgroundEmergency departments are a last resort for some socially vulnerable patients without an acute medical illness (colloquially known as "socially admitted" patients), resulting in their occupation of hospital beds typically designated for patients requiring acute medical care. In this study, we aimed to explore the perceptions of health care providers regarding patients admitted as "social admissions."MethodsThis qualitative study was informed by grounded theory and involved semistructured interviews at a Nova Scotia tertiary care centre. From October 2022 to July 2023, we interviewed eligible participants, including any health care clinician or administrator who worked directly with "socially admitted" patients. Virtual or in-person individual interviews were audio-recorded and transcribed, then independently and iteratively coded. We mapped themes on the 5 domains of the Quintuple Aim conceptual framework.ResultsWe interviewed 20 nurses, physicians, administrators, and social workers. Most identified as female (n = 11) and White (n = 13), and were in their mid to late career (n = 13). We categorized 9 themes into 5 domains: patient experience (patient description, provision of care); care team well-being (moral distress, hierarchy of care); health equity (stigma and missed opportunities, prejudices); cost of care (wait-lists and scarcity of alternatives); and population health (factors leading to vulnerability, system changes). Participants described experiences caring for "socially admitted" patients, perceptions and assumptions underlying "social" presentations, system barriers to care delivery, and suggestions of potential solutions.InterpretationHealth care providers viewed "socially admitted" patients as needing enhanced care but identified individual, institutional, and system challenges that impeded its realization. Examining perceptions of the people who care for "socially admitted" patients offers insights to guide clinicians and policy-makers in caring for socially vulnerable patients.© 2024 CMA Impact Inc. or its licensors.

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