manias-prospectivevalidation-2012.pdf (893.39 kB)
Prospective validation of a predictive model that identifies homeless people at risk of re-presentation to the emergency department
journal contribution
posted on 2012-02-01, 00:00 authored by G Moore, G Hepworth, T Weiland, Elizabeth ManiasElizabeth Manias, M F Gerdtz, M Kelaher, D DuntOBJECTIVE: To prospectively evaluate the accuracy of a predictive model to identify homeless people at risk of representation to an emergency department. METHODS: A 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. RESULTS: Over 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). CONCLUSION: The 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.
History
Journal
Australasian emergency nursing journalVolume
15Issue
1Pagination
2 - 13Publisher
ElsevierLocation
London, Eng.Publisher DOI
Link to full text
ISSN
1574-6267Language
engPublication classification
C Journal article; C1.1 Refereed article in a scholarly journalCopyright notice
2012, College of Emergency Nursing AustralasiaUsage metrics
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No categories selectedKeywords
emergency departmenthomeless peoplehospital re-presentationrisk screeningCohort StudiesEmergency Service, HospitalFemaleHomeless PersonsHospitals, PublicHospitals, UrbanHumansMaleMental DisordersMental HealthModels, StatisticalPatient Acceptance of Health CarePatient ReadmissionProspective StudiesRisk AssessmentRisk FactorsSocioeconomic FactorsSubstance-Related DisordersUrban PopulationVictoriaWounds and InjuriesScience & TechnologyLife Sciences & BiomedicineNursing
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