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Less than one-third of US emergency departments surveyed reported conducting routine screening for adverse SDOH, according to recently published research.

Fewer than one-third of US emergency departments (EDs) surveyed reported conducting routine screening for adverse social determinants of health (SDOH), and only a small fraction have established protocols to respond to positive screens, according to a study published online in JAMA Network Open.

“These findings highlight a substantial gap in the screening and responses for adverse SDOH in US EDs, underscoring the need for enhanced resources and infrastructure to better address social needs in vulnerable ED populations,” wrote corresponding author Melanie F. Molina, MD, MAS, of the University of California, San Francisco.

Survey Findings

The study polled a sample of 232 EDs from the National Emergency Department Inventory–USA to gauge the prevalence of adverse SDOH screening. Of the surveyed EDs, 11.3% were located in the Northeast, 26.4% in the Midwest, 43.6% in the South, and 18.7% in the West. Approximately 80% of facilities were in urban areas.

28.4% of EDs had written policies requiring screening for at least 1 adverse SDOH domain (housing instability, food insecurity, transportation difficulties, or utility payment difficulties), while 71.6% did not perform SDOH screening at all. Some 93.1% of EDs performed such as intimate partner violence, substance use, or mental health conditions.

According to the findings, only 28.4% of EDs had written policies requiring screening for at least 1 adverse SDOH domain—such as housing instability, food insecurity, transportation difficulties, or utility payment challenges. In contrast, 71.6% did not perform SDOH screening at all. Despite this, 93.1% of EDs reported conducting at least 1 other screening required by regulatory agencies, including those for intimate partner violence, substance use, or mental health concerns.

Of the EDs that did conduct any SDOH or other requirement-driven screening, 81.6% had policies requiring some type of follow-up response, most commonly through consultation services (78.2%) or standardized information sheets (43%). Still, researchers emphasized that “approximately 20% of EDs in our sample did not report having policies requiring a response to positive screens,” adding that “screening without response not only represents wasted resources but also risks inducing trauma and eroding patient trust and confidence in the health care system to address their needs.”

Moreover, only 23.4% of EDs offered 24/7 access to social work services, and just 20.5% employed a dedicated ED-based social worker.

Addressing SDOH Needs

The findings suggest an increased responsibility shouldered by ED staff and clinicians in addressing SDOH needs, researchers noted.

“Creative solutions such as telehealth services, financially incentivizing EDs to expand their social work services, or technological innovations such as automated, closed-loop referrals, may be necessary to provide around-the-clock support for patients experiencing adverse SDOH,” they concluded.