title: Navigating the boundaries of emergency department care: addressing the medical and social needs of patients who are homeless.
abstract: OBJECTIVE
  We sought to understand interpersonal and systems-level factors relevant to delivering health care to emergency department (ED) patients who are homeless.
  
  
  METHODS
  We conducted semistructured interviews with emergency medicine residents from 2 residency programs, 1 in New York City and 1 in a medium-sized northeastern city, from February to September 2012. A team of researchers reviewed transcripts independently and coded text segments using a grounded theory approach. They reconciled differences in code interpretations and generated themes inductively. Data collection and analysis occurred iteratively, and interviews continued until theoretical saturation was achieved.
  
  
  RESULTS
  From 23 interviews, 3 key themes emerged: (1) use of pattern recognition in identifying and treating patients who are homeless, (2) variations from standard ED care for patients who are homeless, and (3) tensions in navigating the boundaries of ED social care.
  
  
  CONCLUSIONS
  Our study revealed practical and philosophical tensions in providing social care to patients in the ED who are homeless. Screening for homelessness in the ED and admission practices for patients who are homeless are important areas for future research and intervention with implications for health care costs and patient outcomes.
authors.affiliation: At the time of the study, Kelly M. Doran and Anita A. Vashi were with the Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine/US Department of Veterans Affairs, New Haven, CT, and Department of Emergency Medicine, Yale School of Medicine, New Haven. At the time of the study, Stephanie Platis was with the Yale School of Public Health, New Haven. Leslie A. Curry is with the Yale School of Public Health and the Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven. Michael Rowe is with the Department of Psychiatry, Yale School of Medicine, New Haven. Maureen Gang is with the Department of Emergency Medicine, Bellevue Hospital Center/New York University School of Medicine, New York, NY. Federico E. Vaca is with the Department of Emergency Medicine, Yale School of Medicine, New Haven.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Doran
authors.forename: Anita A
authors.initials: AA
authors.lastname: Vashi
authors.forename: Stephanie
authors.initials: S
authors.lastname: Platis
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
authors.forename: Michael
authors.initials: M
authors.lastname: Rowe
authors.forename: Maureen
authors.initials: M
authors.lastname: Gang
authors.forename: Federico E
authors.initials: FE
authors.lastname: Vaca
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D007396:Internship and Residency; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D009519:New York City; D062072:Patient Acuity; D010343:Patient Admission; D012947:Social Work / Q000458:organization & administration