Abstract
Purpose: To describe the experience of homeless patients arriving at a tertiary care center in Japan, from arrival in the ER to hospital discharge.
Methods: We retrospectively reviewed the clinical course of homeless compared to non-homeless patients presenting to our ER, using six complementary databases to identify all patients. Subsequently, we described and analyzed the characteristics of homeless patients compared with non-homeless patients. We performed a χ2 test for categorical comparisons, and considered p<0.01 to indicate statistical significance.
Results: Compared to non-homeless patients, homeless patients were more likely to arrive to the ER by ambulance (54.5% vs. 19.6%, p<0.001); yet, had significantly lower rates of hospital admission (23.5% vs. 30.2%, p<0.001). A greater proportion of homeless patients arrived to the ER during the day (8am to 6pm) versus after hours (6pm to 8am). Compared to those patients who disclosed their homeless status at the time of their presentation to the ER, those patients who did not disclose their homeless status at the time of their presentation to the ER were more likely to be admitted to the hospital (13.9% vs. 63.7%, p<0.001), and tended to have longer hospital lengths of stay. The common presenting diagnoses of homeless patients were gastrointestinal disorders (23.3%), central nervous system diseases (21.3%) and respiratory diseases (15.5%). Homeless patients who present to the ER with a decreased level of consciousness tend to have longer hospital stays.
Conclusion: Among all patients present to the ER, homeless persons those who disclose their homeless status are less likely to be admitted to hospital in comparison to those who do not disclose, and in comparison to those who are not homeless. These findings indicate that homeless patients in Japan may receive differential treatment from the acute healthcare system.
