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The St Thomas’ Hospital Emergency Department Homeless Health Initiative: improving the quality, safety and equity of healthcare provided for homeless patients attending the ED
  1. Charles Gallaher1,
  2. Simone Herrmann1,
  3. Laura Hunter1,
  4. Alex Wilkins1,2
  1. 1Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
  2. 2The Doctor Hickey Surgery, London, UK
  1. Correspondence to Dr Charles Gallaher; charles.gallaher{at}


We carried out a quality improvement (QI) project (QIP), aiming to improve the quality, safety and equity of healthcare provided for homeless patients attending the emergency department (ED). We used QI methodology to identify areas for improvement, and introduced and modified interventions over four Plan, Do, Study, Act cycles. We launched a departmental ‘Homeless Health Initiative’ (HHI), the chief intervention being the provision of ‘Homeless Health Boxes’ in the ED, which contained a ‘Safe Discharge Checklist for Homeless Patients’, maps to specialist homeless general practitioner surgeries and homeless day centres, information on other inclusion health services, copies of a local rough sleepers’ magazine and oral hygiene supplies. Voluntary Homeless Link Nurses and a number of informal ‘Homeless Health Champions’ were appointed. The HHI was embedded in departmental awareness through regular presentations to staff and incorporation into the induction programme for new doctors. Staff satisfaction, in terms of how satisfied staff members were with the care they were able to provide for homeless patients in the ED on a 0–10 scale, improved modestly over the course of the QIP from median 6/10 to median 7/10. The number of staff who were severely dissatisfied with the care they were able to provide for homeless patients improved more markedly: first quartile staff satisfaction improved from 3.875/10 to 6.125/10. Staff compliance with the checklist was poor, with full compliance observed in only 15% of cases by the end of the QIP. An HHI is a cheap and worthwhile QI project, with the potential to significantly improve the quality, safety and equity of healthcare provided for homeless patients, while improving staff satisfaction concurrently. Similar initiatives should be considered in any ED which sees a significant number of homeless patients.

  • patient discharge
  • emergency department
  • harm reduction
  • healthcare quality improvement
  • patient safety

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  • Contributors CG conceived the project, designed data collection tools, undertook data collection, analysed the data, implemented the interventions, drafted and revised the paper. He is guarantor. SH advised on local resources for homeless people and on suitable interventions and measures, designed the maps, helped implement the interventions and revised the paper. LH helped implement the interventions, with ancillary data collection and revised the paper. AW advised on suitable interventions and measures and revised the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

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