Evaluating a social risk screening and referral program in an urban safety-net hospital emergency department

Stephanie Loo, Emily Anderson, Jessica G. Lin, Perri Smith, Genevra F. Murray, Haeyeon Hong, Gabrielle A. Jacquet, Rashmi Koul, Sophie Rosenmoss, Thea James, Kalpana Narayan Shankar, Pablo Buitron de la Vega

Research output: Contribution to journalArticlepeer-review


Objective: The emergency department (ED) is an opportune venue to screen for unmet social needs and connect patients with social services. This quality improvement study incorporates both qualitative and quantitative data to examine unmet social needs among ED patients and program implementation. Methods: From September 2020 to December 2021, an urban safety-net hospital adult ED implemented a social needs screening and referral program. Trained emergency staff screened eligible patients for 5 social needs (housing, food, transportation, utilities, employment), giving resource guides to patients who screened positive (THRIVE+). We collected screening data from the electronic health record, conducted semi-structured interviews with THRIVE+ patients and clinical staff, and directly observed discharge interactions. Results: Emergency staff screened 58.5% of eligible patients for social risk. Of the screened patients, 27.0% reported at least 1 unmet social need. Of those, 74.8% requested assistance. Screened patients reported housing insecurity (16.3%) as the most prevalent unmet social need followed by food insecurity (13.3%) and unemployment (8.7%). Among interviewed patients, 57.1% recalled being screened, but only 24.5% recalled receiving resource guides. Patients who received guides reported little success connecting with resources and supported universal guide dissemination. Staff expressed preference for warm handoff to social services. Of 13 observed discharge interactions, clinical staff only discussed guides with 2 patients, with no positive endorsement of the guides in any observed interactions. Conclusions: An ED social needs screening program can be moderately feasible and accepted. We identified housing as the most prevalent need. Significant gaps exist between screening and referral, with few patients receiving resources. Further training and workflow optimization are underway.

Original languageEnglish (US)
Article numbere12883
JournalJACEP Open
Issue number1
StatePublished - Feb 2023


  • emergency department
  • quality improvement
  • safety net
  • social determinants of health
  • social emergency medicine
  • social needs screening

ASJC Scopus subject areas

  • Emergency Medicine


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