(050) Enhancing Support for Persons Experiencing Homelessness Following Hospital Discharge: Feasibility Demonstration of a Street Medicine Consult Mechanism

Background/Significance: Medically hospitalized patients experiencing homelessness (PEH) face risks at discharge resulting in poor outcomes and readmissions. Given higher rates of mental illness and substance use among PEH, consultation-liaison psychiatry (CL) teams are often closely involved in the care of PEH. Street medicine programs support PEH after discharge by providing aftercare and linkage to outpatient services, including psychiatric treatment, though systemic barriers prevent optimal coordination with inpatient providers. Our goal was to create a pathway supporting PEH at discharge utilizing interdisciplinary care with our institution’s CL providers, Discharge Plan Managers (DPMs) at our medical hospital (i.e., social workers and care managers), and a community street medicine program. We conducted a stakeholder-driven needs assessment, using these data to pilot a consult mechanism facilitating warm handoffs between our hospital and street medicine providers.

Methods: We conducted semi-structured interviews with street medicine and inpatient hospital staff, including CL staff, to assess opportunities for improvement of care for PEH. We then disseminated a pre-intervention survey to DPMs (n=36) and our CL team (n=40) to assess practices and attitudes regarding caring for PEH. Using this information, we recruited champions from the DPM and CL teams to develop the consult mechanism, held an orientation and engagement meeting, and activated a “Consult Street Medicine” order in the electronic medical record triggering a call to the street medicine team. We conducted chart review on patients for whom an order was placed. This project was approved by our Quality Review Committee.

Results: Key themes in interviews included high demand for street medicine resources, uncertainty regarding outcomes after discharge for PEH, and need for enhanced communication between hospital teams and street medicine providers. Survey results show respondents encounter PEH frequently (49% stating once per week or more), feel this work is within their scope of practice (74%), and is important for good outcomes (97%). However, many do not feel comfortable talking to patients about homelessness (36%) and do not feel equipped to handle their needs (73%). Most did not consistently collaborate with community organizations (81%). After implementation of street medicine consultation the order was placed 21 times on 17 unique patients in a 3-month span, and 64% of unique patients saw both psychiatry and street medicine during at least one admission.

Discussion: We demonstrate feasibility, enthusiastic participation, and qualitative benefits of a stakeholder-driven street medicine consult mechanism championed by CL psychiatry and implemented at a local hospital. We will conduct a post-intervention survey of DPMs to assess experiences with the pilot and explore billing opportunities to establish sustainability.

Conclusion/Implications: CL psychiatrists are uniquely positioned to play a key role in such a process, and we believe a similar program could be implemented at other institutions to improve the care of PEH.