Homeless Hospital Assessment Tool

Dr Bruce Taylor, from Gloucestershire Hospitals Foundation Trust, sets out why he’s helped to develop a hospital admissions assessment tool for those experiencing homelessness:

Until the day homelessness is solved, we welcome everyone, housed or not, into our hospital.

Our homeless patients are 6 times more likely to attend A&E and 4 times more likely to be admitted into hospital, with their admission being 3 times longer than that of our patients who have a permanent roof over their head. This is therefore a great opportunity to engage with our patient, treat them, and refer them on where necessary.

Our typical process in ED is to complete Duty to Refer applications; call the Housing Officer and Homeless Specialist Nurse; and contact the drug and alcohol teams . All this within a few hours. Our job (seemingly) done.

But, wait, surely there is so much more we could achieve in the short time we have?

Just as we have the one-hour window to recognise and initiate treatment for sepsis to avoid terrible morbidity, why not use this opportunity to undertake a comprehensive, global assessment of a homeless patient within their first hour of admission?

We realised that for certain patients, their admission to hospital was a golden opportunity to give more help. With input from Dr Pippa Medcalf, I designed the Homeless Assessment Tool (HAT).

On one side of A4, this Tool is a comprehensive checklist for every doctor and nurse to commence at admission and run through as an aide memoire when caring for our homeless patients. Blood borne virus screen? Check. Nutrition? Check. Sexual health issues? Check. The HAT has it covered.

We have begun educating our junior doctors working within the Trust on the HAT’s importance and how we will roll it out. We are now moving to have it embedded in our hospital IT system so the checklist appears and is activated automatically when a homeless person is admitted.

We have a wonderfully unique and opportunistic moment to really make a difference while homeless patients are under our roof. The HAT ensures we are truly addressing and managing the dynamic and complex care needs of our homeless patients, with a holistic and multi-disciplinary approach, aiming to streamline their admission and their discharge.