Safe discharge planning for unhoused patients in emergency departments: Addressing vulnerability and continuity of care

INTRODUCTION: Unhoused patients or people experiencing homelessness may rely on emergency departments for care. Often, they face challenges at discharge owing to a lack of stable housing, limited access to follow-up care, and complex social needs. This quality improvement project aimed to evaluate discharge practices for people experiencing homelessness with mobility deficits and identify opportunities for improving continuity of care. 

METHODS: A safe discharge process and checklist were created with an interdisciplinary team. Concurrent with implementation, daily reports and chart reviews were conducted of people experiencing homelessness identified in the emergency department between September 2024 and February 2025. Data collected included consultations to case management, consultation completion, mobility concerns, and discharge disposition. 

RESULTS: Only 3.8% of identified people experiencing homelessness who met the criteria for people experiencing homelessness with mobility deficits were referred to case management or social services for the safe discharge checklist. There was a completion percentage of 35% overall; however, upon reevaluation of the inclusion criteria for patients experiencing homelessness with mobility deficits, there was a completion status of 100% of the safe discharge process. 

DISCUSSION: Discharge planning for people experiencing homelessness remains inconsistent, with limited linkage to outpatient care and support services. These findings highlight the need for standardized discharge protocols, integration of case management services, and partnerships with community organizations to reduce emergency department recidivism and improve outcomes for this vulnerable population.