Help indigent patients and see return visits drop

Improve staff morale and help your community

When a homeless patient comes to the ED at Bellevue Hospital Center in New York City, he or she leaves not only with appropriate medical treatment, but also with clothing and a meal, reports Lewis Goldfrank, MD, director of emergency medicine.

"We give out tens of thousands of coats, pants, and shirts on an annual basis," he says. "This allows the person on the street to achieve some level of dignity upon discharge."

Such charitable practices benefit the patients and ED staff, says Norman C. Christopher, MD, director of pediatric emergency medicine at Children’s Hospital Medical Center of Akron (OH).

"The reward we see, in addition to our own satisfaction, is that we are able to develop a tremendous loyalty’ by families and agencies in our area," he notes.

Acts of charity also boost staff morale, according to Christopher. "It is uplifting to the staff to participate in projects that benefit our patients, their families, and the community at large," he says.

Here are ways to help indigent patients in your ED:

• Give free starter prescriptions. At Children’s ED, "starter" packs are given to patients, with a prescription to be filled at a more convenient time. "The goal is to reduce return visits and worsening of conditions because of the inability to fill a prescription," Christopher says.

This service most often is offered in the middle of the night, on weekends, or for out-of-town patients and isn’t directed specifically at the indigent, he notes. "However, when a family appears to be ’needy’ or expresses that type of need, we also invoke this approach," he says.

Sometimes, patients come in for a specific chief complaint but seem to have problems that aren’t easily defined, notes Goldfrank. "These are ideal patients to talk with about general health care understanding, potential for domestic violence, fear of immigration issues, or psychosocial needs," he says.

Blaming the patient for using the ED inappropriately is the wrong attitude, he contends. "We fill the gaps in our society for particularly needy individuals such as the . . . impoverished American or immigrant."

• Offer a wide range of social services. Your ED needs an ongoing social services effort that focuses on the specific needs of your community, stresses Goldfrank. "It is essential to understand the educational and income needs of the people we serve."

Immigrants receive targeted services

The Bellevue ED has a diverse patient population with 25% immigrants, many of whom have never had basic health care, he reports. The ED’s services focus on crime victims, including victims of sexual assault and domestic violence; shelter referrals; substance abuse interventions; ambulance discharge from the ED; child placement and assessment; HIV testing; and home care referrals, he says.

In addition, referral to a social worker is available 24 hours a day, seven days a week, to assist patients with services such as job placement and lodging, he explains.

A large percentage of the ED’s patients have a household income under $20,000, notes Goldfrank. To address the fact that many patients have income limitations, patients with conditions that require follow-up care such as pneumonia or congestive heart failure are given free medication and a primary care appointment, he says. "In our setting, a plan is established for immediate follow-up, regardless of the patient’s financial resources." That plan often avoids a return ED visit, he notes.

The ED also sees significant numbers of patients whose reading levels are below the third grade, says Goldfrank. Educational and discharge materials that are appropriate for those patients are available.

At Children’s Hospital Medical Center of Akron, social service representatives are available in the ED 24 hours a day. For six of those hours, the representatives are on call from home.

"This expert staff is always available to provide support services for families," Christopher says. For example, shelter referrals can be made for victims of domestic violence. Several support groups are available for families with special needs children, such as premature infants or children with chronic diseases, he notes.

• Adopt families during the holidays. Used toys, books, clothing, and coats are provided to needy families during the winter season, particularly at holidays, Christopher says. "Several families are also adopted’ by the ED every Christmas and Thanksgiving season. We provide them with meals, age-appropriate presents, and clothing."

The ED also has a standing arrangement with a local organization to provide baseball tickets for families who can’t afford them. "This is a nicety that is appreciated greatly by families here," Christopher says.

• Provide transportation. The ED provides transportation home for patients who are able to document a real need, he notes. "For example, a family with only one vehicle was involved in a motor vehicle crash," he says. "There are other less dramatic scenarios where we would provide this service as well."

• Donate car seats. The ED provides car seats for families leaving with infants and/or younger children who are without them. "We always hope to get the seats back [when the family purchases one of their own], but we never really expect to," says Christopher.

The ED is active in this area because the hospital is the only pediatric resource in the immediate area, he notes. "I really feel that this is a responsibility we have to meet." (See story on the ED’s role as a "safety net," at right.)

Sources

• Norman C. Christopher, MD, Children's Hospital Medical Center of Akron, Emergency Administration, 1 Perkins Square, Akron, OH 44308-1062. Phone: (330) 543-8608. Fax: (330) 543 -3761. E-mail: NChristopher@chmca.org.

• Lewis Goldfrank, MD, Bellevue Hospital Center, Department of Emergency Medicine, First Ave. and 27th St., Room 345A, New York, NY 10016. Phone: (212) 562-3346. Fax: (212) 562-3001. E-mail: lgoldfr@bhc.org.