• Gaye Moore, Graham Hepworth, Tracey Weiland, Elizabeth Manias, Marie Frances Gerdtz, Margaret Kelaher, and David Dunt.
• Melbourne School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, Victoria 3010, Australia. dgmoore@optusnet.com.au
• Australas Emerg Nurs J. 2012 Feb 1;15(1):2-13.

ObjectiveTo prospectively evaluate the accuracy of a predictive model to identify homeless people at risk of representation to an emergency department.MethodsA prospective cohort analysis utilised one month of data from a Principal Referral Hospital in Melbourne, Australia. All visits involving people classified as homeless were included, excluding those who died. Homelessness was defined as living on the streets, in crisis accommodation, in boarding houses or residing in unstable housing. Rates of re-presentation, defined as the total number of visits to the same emergency department within 28 days of discharge from hospital, were measured. Performance of the risk screening tool was assessed by calculating sensitivity, specificity, positive and negative predictive values and likelihood ratios.ResultsOver the study period (April 1, 2009 to April 30, 2009), 3298 presentations from 2888 individuals were recorded. The homeless population accounted for 10% (n=327) of all visits and 7% (n=211) of all patients. A total of 90 (43%) homeless people re-presented to the emergency department. The predictive model included nine variables and achieved 98% (CI, 0.92-0.99) sensitivity and 66% (CI, 0.57-0.74) specificity. The positive predictive value was 68% and the negative predictive value was 98%. The positive likelihood ratio 2.9 (CI, 2.2-3.7) and the negative likelihood ratio was 0.03 (CI, 0.01-0.13).ConclusionThe high emergency department re-presentation rate for people who were homeless identifies unresolved psychosocial health needs. The emergency department remains a vital access point for homeless people, particularly after hours. The risk screening tool is key to identify medical and social aspects of a homeless patient's presentation to assist early identification and referral.Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

34 keywords...

hide…