EDs Struggle to Screen, Respond to Social Determinants of Health, Survey Finds

Most US emergency departments (EDs) aren't screening patients for social risks like housing instability or food insecurity, even though nearly all screen for issues like substance use and mental health, according to new survey results that highlight persistent gaps in addressing social determinants of health (SDOH) in acute care settings.¹

Most US emergency departments aren't screening patients for social risks like housing instability or food insecurity.

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The national study published in JAMA Network Open reveals that fewer than 1 in 3 EDs conduct routine screening for adverse SDOH, and even fewer have dedicated staff and resources to provide meaningful support.

Jubril Oyeyemi, MD, chief medical officer of Camden Coalition, medical director of Community Health Institute at Virtua Health, and founder and CEO of Cherry Hill Free Health Clinic, addressed the importance of SDOH screening in these settings, articulating common ways EDs may be falling short.²

"At a time when approximately one-third of Americans lack a primary care provider, the hospitalist has assumed that role for patients with complex care needs. But in today’s health care systems, patients with [health-related social needs] who are initiating care through acute ED or hospital settings are encountering unfamiliar faces each time," Oyeyemi wrote in The American Journal of Managed Care^®. "There is no shared history of care, no context for what this individual truly needs help with beyond what is shared in their [electronic medical record] data, and therefore, there is little continuity to their complex care needs. The patients who often need the most from us are constantly starting over."

In the new cross-sectional survey study, researchers collected responses from 232 emergency departments across the United States—an 83% response rate—from a stratified 5% random sample of the National Emergency Department Inventory–USA.¹ The survey assessed the presence of written policies for screening and responding to common adverse SDOH domains: housing, food, transportation, and utility payment difficulties.

Of the 280 EDs surveyed, 232 responded to questions on screening policies, representing 4% of all US EDs in 2022. Most of these EDs (80.5%) were located in urban areas, and the average annual patient volume was over 28,000 visits. While more than 9 in 10 EDs (92.2%; 95% CI, 86.9%-95.5%) had some form of social work services available, only about 1 in 5 (20.5%; 95% CI, 14.2%-28.6%) had a dedicated ED-based social worker, and just 23.4% had social work available around the clock (95% CI, 17.1%-31.2%).

Despite widespread awareness of the importance of SDOH, only 28.4% of responding EDs had written policies to screen for at least 1 adverse SDOH, such as housing instability, food insecurity, transportation difficulties, or trouble paying for utilities (95% CI, 21.0%-37.2%). The vast majority (71.6%) did not conduct screening in these areas (95% CI, 62.8%-79.0%). In contrast, 93.1% of EDs reported screening for requirement-driven risk factors, including intimate partner violence, substance use, and mental health concerns (95% CI, 89.2%-95.7%).

Among those with policies for specific adverse SDOH, housing instability was the most commonly screened domain (22.7%; 95% CI, 16.3%-30.6%), followed by food insecurity (14.9%; 95% CI, 9.6%-22.5%), transportation difficulties (13.1%; 95% CI, 8.2%-20.2%), and utility payment struggles (4.0%; 95% CI, 2.1%-7.6%).

When EDs did have screening policies in place for adverse SDOH or requirement-driven factors, most (81.6%) also had a formal response policy. These response strategies varied: nearly 8 in 10 (78.2%; 95% CI, 67.2%-86.3%) used consultation services such as social work; 43.0% provided standardized resource sheets (95% CI, 32.5%-54.3%); 12.9% offered individualized information via tools like UniteUs (95% CI, 7.2%-21.8%); and 10.8% reported other types of responses (95% CI, 5.4%-20.3%).

Social work consultation was the most common approach across all domains, with particularly high use in response to issues with housing (84.8%; 95% CI, 61.7%-95.1%), transportation (96.0%; 95% CI, 80.9%-99.3%), and utilities (100.0%). Standardized information was frequently used for housing (51.8%; 95% CI, 33.0%-70.1%). Standardized information was also common regarding utilities needs (57.6%; 95% CI, 23.8%-85.5%), but individualized resource mapping remained rare (39.3%; 95% CI, 13.3%-73.1%).

Interestingly, the study found that 24/7 availability of social work services did not significantly increase the likelihood of EDs implementing screening or response policies for adverse SDOH, suggesting that while infrastructure like social work services is critical, additional factors likely influence whether EDs formalize efforts to identify and address social needs. After adjusting for ED characteristics such as academic affiliation, urban location, and visit volume, 24/7 social work access was not significantly associated with screening policies (OR 1.90; 95% CI, 0.79-4.58) or response policies (OR 1.68; 95% CI, 0.58-4.88).

"The discrepancy between the high prevalence of adverse SDOH among vulnerable ED populations and the low rates of screening impedes the delivery of high-quality, comprehensive care that both considers and addresses unmet social needs in clinical care plans," the authors wrote. "It risks perpetuating poor health outcomes and exacerbating existing health disparities."

References

1. Molina MF, Cash RE, Loo SS, et al. Screening and response for adverse social determinants of health in US emergency departments. JAMA Netw Open. 2025;8(4):e257951. doi:10.1001/jamanetworkopen.2025.7951

2. Oyeyemi J. Contributor: For complex cases, continuity in acute care is necessary. AJMC. April 23, 2025. Accessed April 23, 2025. https://www.ajmc.com/view/contributor-for-complex-cases-continuity-in-acute-care-is-necessary