Documentation of adverse social drivers of health in US emergency departments

OBJECTIVES: This study aimed to characterize emergency department (ED)-based policies related to documentation of adverse social drivers of health (aSDOH) among a national sample of US EDs. 

METHODS: We conducted a cross-sectional survey of ED leaders from a 5% stratified random sample of US EDs (n = 280) from January to October 2023. For EDs reporting written screening policies for core aSDOH (housing, food, transportation, and utilities) or regulatory requirement-driven screening (intimate partner violence, other violence, substance use, and mental health), we assessed documentation policies, including personnel responsible and documentation methods. Using survey-weighted analyses and multivariable logistic regression, we examined associations between documentation policies and ED characteristics (practice setting, urbanicity, visit volume, and 24/7 social work availability). 

RESULTS: Of 232 responding EDs (83% response rate), 213 (93.2%, 95% CI, 89.3-95.7) reported screening for at least 1 risk factor. Among these, 196 (93.8%, 95% CI, 87.9-96.9) had policies requiring documentation of positive screens. Documentation requirements were higher for regulatory requirement-driven screening (84-93.5) compared with core aSDOH screening (56.8-68.9). Clinical providers most commonly documented findings (97.8%, 95% CI, 94.8-99.1), followed by social workers/care coordinators (52.6%, 95% CI, 42.4-62.6). All documentation occurred in the electronic health record. In adjusted analyses, 24/7 social work availability was associated with greater odds of having at least 1 aSDOH documentation policy (odds ratio, 2.86; 95% CI, 1.09-7.52). 

CONCLUSION: Although most EDs with screening policies required documentation of positive screens, requirements varied by domain. Future research should focus on standardizing documentation practices and developing systems to effectively translate documented social needs into meaningful interventions.