Implementation of Food Insecurity Screening in an Urban Adult Emergency Department

Abstract

Problem. Over one-third of Baltimore City residents live in Healthy Food Priority Areas, which are associated with unmet medical and social needs, including food insecurity. Patients visiting the implementation site, an urban Emergency Room are at high risk of experiencing food insecurity but are not regularly screened for FI. Purpose: The purpose of this quality improvement project (QI) was to implement the two-question Hunger Vital Sign Screening (HVS) in an adult ER. The QI project aimed to screen patients for food insecurity and connect them to local community food resources as well as social workers. Methods: Over a 15-week period from September through December 2022, eligible patients visiting the adult ER were screened for food insecurity using the HVS tool. Patients screening positive received a sheet with local food resources as well as spoke with Social Worker if they needed further information. Data was collected through bi-weekly chart audits. Data collected included the percentage of patients screened for FI, the number of positive screens, and the number of positive screens receiving community resources and/or being referred to social work. Staff satisfaction with the QI intervention was analyzed via a post-intervention Feasibility/ Acceptability Survey. Results: Results reflected an average screening rate of 7% of patients for FI during their ER visit. Thirty percent of patients screened were positive for food insecurity and 100% of those patients received a community food resource sheet. 28% of the FI patients were referred to social work upon request. Eighty-eight percent of staff felt the screening tool was acceptable to use and felt prepared to administer it. Conclusions: Despite several barriers to implementing the HVS in the ER; a third of patients who were screened were positive for FI indicating a need for intervention.