The role of the emergency department in the care of homeless and disadvantaged populations

Emergency departments (EDs) provide the only universal health care accessible to the general public in the United States, with well over 100 million patient visits per year [1,2]. Operating at the critical interface between the hospital and its community, EDs are designed to meet the demands of all patients. Whereas the specific needs of each community will vary, the fundamental approach to delivering emergency care remains the same-dedicated health professionals work 24 hours a day, 7 days a week to provide care to all patients, regardless of social circumstance. Because the ED functions as the ultimate health care "safety net," it can have a critical impact on homeless and other disadvantaged populations [3]. This chapter will review the epidemiology of social deprivation among ED patients, with a particular focus on understanding the nature of homelessness. It will then explore the value of an integrated approach to socio-medical care in the ED, and highlight successful ED-based approaches.