Effect of the Homeless Health Response Bundle on reattendances to an emergency department within 28-days

Intervention Group People attending the emergency department at St Vincent's Hospital Melbourne will be screened for homelessness by a research assistant. Those identified as experiencing any level of homelessness will be invited to participate in this study. Prior to randomisation, participants will be invited to complete a satisfaction with life domains scale. Participants randomised to the intervention group will receive the Homeless Health Access to Care Tool. The Tool has 24-items and is designed to assess the level of health related vulnerability of a person experiencing homelessness. The Homeless Health Access to Care Tool will be administered by a member of the Assessment Liaison Emergency Early Referral Team (ALERT). The ALERT are a multidisciplinary team of social workers, nurses and support workers, who assess people attending the Emergency Department with a view to establishing social services support. It will take approximately 7 minutes to administer the Homeless Health Access to Care Tool. The Tool will be administered only once during a person's attendance to the Emergency Department. The Tool will be electronically embedded into the Emergency Department database. The Homeless Health Access to Care Tool measures health-related vulnerability defined as a person’s burden of disease and/or injury combined with their capacity to access care, in terms of their ability to seek, perceive, reach, pay and engage healthcare (Levesque et al., 2013). The level of vulnerability identified by applying the Tool will be fed into a site-specific Decision Assistance Guide that will direct the prioritisation of care and healthcare providers’ response to the person experiencing homelessness. For example, a person presenting to the Emergency Department who is deemed highly vulnerable via the Homeless Health Access to Care Tool, will be comprehensively assessed with consideration of screening for chronic disease, cognitive impairment, housing assessment, and admission to the short stay unit in the Emergency Department. The application of the Decision Assistance Guide will be led by the ALERT staff member that administered the Homeless Health Access to Care Tool, in collaboration with the medical and nursing staff involved in the participant's care. Once the Homeless Health Access to Care Tool has been administered, the participant will be assessed by a medical practitioner or nurse practitioner within the Emergency Department. As stated above, the Decision Assistance Guide will be applied to decisions relating to the persons care. Adherence to the Homeless Health Access to Care Tool and Decision Assistance Guide will be monitored daily by the research assistants and weekly by the on-site research coordinator. Once the decision has been made to discharge or admit the participant, a research assistant will invite the participant to complete a satisfaction with care survey. The participant will then be provided with a $20 supermarket voucher. The medical records of each participant will be reviewed at 28 days post attendance by a member of the research team, to identify the number of re-attendances during this period. The medical attendance record from their attendance will also be examined for their, length of time waiting to be seen, length of time in the Emergency Department, referrals to other health professionals, disposition, triage category. At 30-days a research assistant will contact the participant by phone or in person to conduct the satisfaction with life domains scale. Once completed a $20 voucher will be provided to the participant. A participant involved all the way through this study will receive a maximum of two $20 vouchers.