Screening and Response for Adverse Social Determinants of Health in US Emergency Departments

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Importance: Regulatory agencies have begun incentivizing screening for adverse social determinants of health (SDOH) and responses in inpatient settings, missing a crucial safety net: the emergency department (ED). Little is known about the prevalence of ED-based adverse SDOH screening and response practices nationally. Objective: To describe the prevalence of ED-based adverse SDOH screening and response policies and to identify associated hospital characteristics. Design, Setting, and Participants: This survey study utilized a 5% random sample from the National Emergency Department Inventory-USA, including EDs stratified by geography, urbanicity, and practice setting (academic vs community). Data regarding 2022 policies were collected in 2023. Exposures: Practice setting, urbanicity, visit volume, and availability of social work. Main Outcomes and Measures: The presence of written policies for any adverse SDOH (housing, food, transportation, and utility payment difficulties) screening and responses, as well as other requirement-driven screening for SDOH risk factors (intimate partner violence, substance use, and mental health conditions). Responses were categorized as consultations (eg, social work), standardized information sheets, individualized resource information, or other. Results: Of a total of 280 EDs, 232 responded (83% response rate). Among 232 EDs, 28.4% (survey-weighted proportion; 95% CI, 21.0%-37.2%) had screening policies for at least 1 adverse SDOH domain, and 93.1% (95% CI, 89.2%-95.7%) performed at least 1 other requirement-driven screening (eg, intimate partner violence). Of EDs performing any screening (adverse SDOH or other), 81.6% (95% CI, 73.4%-87.7%) had response policies, primarily involving consultations (78.2%; 95% CI, 67.2%-86.3%), standardized information sheets (43.0%; 95% CI, 32.5%-54.3%), and individualized resource information (12.9%; 95% CI, 7.2%-21.8%). Among all responding EDs, only 23.4% (95% CI, 17.1%-31.2%) had around-the-clock social work availability, and 20.5% (95% CI, 14.2%-28.6%) had an ED-based social worker. There was no association between practice setting, urbanicity, visit volume, or around-the-clock social work with adverse SDOH screening or response policies. Conclusions and Relevance: Despite the high prevalence of adverse SDOH in ED populations, in this survey study of 232 EDs, less than one-third performed screening, and one-fifth did not have policies requiring a response to positive screens. Bridging this gap may require expanding adverse SDOH screening practices while also ensuring that EDs have the resources and infrastructure to respond appropriately to identified social needs. Future research might explore advanced technological solutions to enhance screening and responses in these resource-constrained settings.

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