Current Practices in ED Social Determinants Screening and Care Connection: A Literature Review

Abstract

Social determinants of health (SDOH) screening in emergency departments (ED) is a promising method to capture and address individualized social needs of a broad patient population, ideally lowering emergency department readmissions while reducing health disparities. With new Joint Commission guidelines requiring social determinants to be addressed and integration of SDOH-related Z-codes into ICD-10 coding, the time is now to implement robust screening and referral programs. This narrative literature review strives to identify best practices prior to the implementation of social determinants screening in the ED of University Medical Center, New Orleans. We investigate current screening tools and their integration with electronic health records, discuss survey formats, detail referral processes, and resource navigation post screening, and describe care connection models from screening to referral. Key conclusions include the identification of the Protocol for Responding to & Assessing Patients' Assets, Risks & Experiences (PRAPARE) as the ideal screening tool, and that electronic screening tools led to higher levels of social needs reporting compared to paper counterparts. Similar success of written resource referrals and referrals given by a navigator in reducing social risk factors was also identified, highlighting the importance of high-quality, written resource referrals. Lastly, challenges to formation of a successful, integrated screening and referral pathway such as loss to follow-up, even in a transition care coordination model that assists patients throughout levels and types of care, are identified.