Identification and documentation of patient social risk factors in the prehospital setting: a pilot implementation

OBJECTIVES: Social risk factors (SRF), or adverse social drivers of health, have become an increased area of focus in health care, particularly among Emergency Medical Services. Prehospital identification and response to SRFs have been reported, most notably among mobile-integrated models, such as Community Paramedicine. Incorporating SRF screening within routine EMS practice is not standard, despite reports of willingness to do so among clinicians. Therefore, it was the aim of this study to evaluate the integration of a prehospital SRF documentation tool. 

METHODS: A 14-item prehospital SRF documentation tool derived from the World Health Organization's social determinants of health categories was integrated into our EMS agency's patient charting platform as a required field on July 11, 2024. We conducted a retrospective cohort study of all adult emergency and non-emergency calls from the start of integration to January 11, 2025 to evaluate overall identification and prevalence of reported SRF. Descriptive statistics were used to characterize the study sample. Bivariate statistics were used to evaluate differences across demographic and encounter level variables and SRF type using Chi-Square tests and Wilcoxon rank-sum tests, where appropriate. Covariates were further evaluated by whether they had a documented SRF or not. 

RESULTS: A total of 57,899 encounters were identified, with 4.0% having at least one documented SRF (n = 2,326); the remaining sample had no SRFs documented. The SRF sample overall was 66.9% male, 28.9% White and median age of 50 years (IQR: 36-66), and 30.8% had more than one SRF identified. There were 116 individuals that had more than one encounter during the study time period. The most frequently reported SRFs were substance use (31.3%), housing instability (25.7%) and disability (25.4%). Over 75% of encounters were low acuity. Compared to encounters with no SRFs documented (n = 55,573), patients were older and female (p-values >0.05). 

CONCLUSIONS: Identified SRFs were low among our sample, highlighting the need to determine the barriers preventing recognition and reporting. Young males are a high-risk group, particularly for repeated encounters. There is a need to identify improved mechanisms for EMS clinicians to document and communicate pertinent SRF information, particularly to Emergency Department teams.