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A&E audit reveals standards for homeless patients not being met

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Emergency department nurses and other clinicians are being urged to improve their care for homeless people after an audit revealed a series of fundamental standards were not being met.

In the first national clinical audit of A&E care for homeless – which looked at data from 22 trusts and hospitals across the UK over two weeks this winter – it was found that in many cases homeless patient past attendances and their medication history were not being recorded.

“Homelessness is estimated to have increased by 40% over the past four years, therefore it is essential that ED staff are trained appropriately”

RCEM audit of A&E care for homeless patients

Meanwhile, further assessments for mental health or drug and alcohol use were also not being documented by clinicians, according to the report jointly led by the Royal College of Emergency Medicine.

The audit measured how many departments were meeting eight “fundamental” and five “developmental” standards for patients jointly published by The Faculty for Homeless and Inclusion Health and RCEM in September.

It found that while care for these patients was good overall, there were many ways it could be improved.

A total of 294 homeless people were included in the audit, in which 60% had their drug and alcohol history documented.

Only a quarter of the 146 homeless patients in which drug or alcohol use was the direct cause for presentation were referred for specialist assessment.

“Homelessness can have a devastating impact on people’s health… more needs to be done to ensure they can access the help they need”

Jon Sparks

Meanwhile, among the 44 homeless patients in which a mental health problem was documented, just 55% were recorded as having had a risk assessment and were referred to a mental health liaison team.

Around half of the homeless patients were not registered with a local GP, and in these instances, clinicians failed to provide any further advice or information about registration in around 85% of cases.

Records of homeless patient attendances in the past three months were found in 48% of cases and more than a third of patients’ medication history was not documented in their notes.

A second audit carried out at the same time by the RCEM looking at organisational approaches to care for homeless people in A&E found only three hospitals had a homelessness staff information pack available that was reviewed annually.

The RCEM noted emergency departments were “ideally placed” to support the work of primary care teams due to the higher likelihood of attendance in this setting.

“Homelessness is estimated to have increased by 40% over the past four years, therefore it is essential that ED staff are trained appropriately,” it added.


Dr Clifford Mann

Clifford Mann

In a statement, RCEM president Dr Cliff Mann said: “Homeless people represent some of the most vulnerable individuals in our society. It is surely a marker of a civilised society that care and concern for these people is reflected in the provision of appropriate healthcare services.”

He added: “Homeless patients coming to our EDs this winter deserve the very best care. This work is the first step in contributing to raising standards in this area as a specialty. We are fighting to support our clinicians to reduce health inequalities for excluded groups.”

Jon Sparks, chief executive of homeless charity Crisis, said: “Homelessness can have a devastating impact on people’s health. The average age of death for a homeless person in this country is just 47, compared to 77 in the general population.

“Despite this we know from our services that they often struggle to access the support they need when they go to A&E. That is why this study is so important: more needs to be done to improve the health of homeless people and ensure they can access the help they need.”

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Readers' comments (1)

  • michael stone

    I hope this situation improves - there are obvious problems with providing decent healthcare for homeless people, but at the very least we should be making a serious attempt to do that.

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