Comment

Board’s eye view - Life after discharge

Staff in my emergency department (ED) were saddened recently by the death of a young homeless man with whom they had become well acquainted. He was a regular rough sleeper in Belfast, and well known and liked in the homeless community.

Staff in my emergency department (ED) were saddened recently by the death of a young homeless man with whom they had become well acquainted. He was a regular rough sleeper in Belfast, and well known and liked in the homeless community.

Many homeless people have complex physical and mental health needs, often due to drug and alcohol dependency, but have little social support and are at an increased risk of premature death.

As a result, homeless people are often frequent ED attendees. A 2010 report from the Department of Health states that 89% of all episodes involving people of no fixed abode are recorded as emergencies, compared with 41% for the rest of the population.

When discharging homeless people from EDs, staff often fear non-compliance with treatment regimens, such as antibiotic use and wound care, and an inability or unwillingness to access primary care services. However, such staff are ideally placed to support the work of primary care teams and other agencies to help prevent ED re-attendances among homeless people.

The Royal College of Emergency Medicine (RCEM) has found that, while ED care of homeless people is good overall, it can be improved. But such improvement requires multi-agency co-ordination, and close links to appropriate services and support.

The RCEM, in partnership with the Faculty for Homelessness and Inclusion Health and the Royal College of Physicians, is developing tools to support EDs to improve the care of homeless people and support staff in attempting to reduce health inequalities.

Regardless of how and why people end up homeless, they did not start their lives this way, and they deserve to receive high quality care.

About the author

Linsey Sheerin is clinical co-ordinator at Royal Victoria Hospital in Belfast, Northern Ireland and member of the Emergency Nurse editorial advisory board.

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