Why deeming patients ‘socially admitted’ may be detrimental to their outcomes

“Social admissions;” “orphan patient;” “failure to cope.”Labelling patients this way isn’t working. These titles are often attached to a group of patients who present to emergency departments because of a number of factors preventing them from being able to cope at home. “The ‘social admission’ phenomenon is an under-researched area in healthcare,” wrote Dr. Jasmine Mah, an internal medicine resident at Dalhousie University, with her coauthors, in new qualitative study looking at this cohort in Nova Scotia. “These patients, often categorized by healthcare providers as not being acutely ill, experience in-hospital death rates as high as 22.2%–34.9%. Explanations may include under-triaging in the emergency department owing to poor recognition of atypical clinical presentations and delays in timely assessments.”Published in CMAJ, the study authors suggest labelling patients this way can cause several problems, such as “incorrect assumptions about medical needs and cognitive abilities, which impedes opportunities to look for treatable medical issues.”The researchers found these labels can lead to a “downgrading” of the care these patients receive—often being looked after by health team members will less experience “recognizing evolving medical presentations or lack the authority to advocate strongly for clinical reassessments when needed.” “The implication that the care of ‘social admissions’ should be delegated to others reflects an implicit attitude of hierarchy and detachment from the needs associated with this patient population,” the researchers wrote.Indeed, the term “failure to cope” is a pejorative, they note, as it lays the fault for their present situation on the patient. The authors stressed that “patients are not to blame for the fact that home care is inadequate, long-term care is unavailable for a patient who really needs it, or lack of access to secure housing means managing a chronic condition in the community is impossible.” They therefore suggest a reframing is needed to confront the problem with real solutions—moving away from punitive approaches like forcing patients to move to a long-term care bed unreasonably far from their family supports. “Nonpunitive approaches are better for patients and decrease hospital admissions and costs. One approach is to embed personnel and programs that address the complex care needs of patients at risk of needing “social admission” within emergency departments.”The authors recommend peer support worker programs, wherein people with similar experiences to these patients help establish trust with the clinical team and help navigate patients through available supports for problems like homelessness, mental illness or substance use. “Recent literature on peer support workers in hospital-based settings shows that they provide critical support for patients accessing social supports and harm-reduction services,” they wrote. Further, the authors point to increasing use of specialists in geriatric care within emergency departments to help patients experiencing frailty and issues with cognition. Fundamentally, they write, none of these solutions are a “replacement” for the needed community infrastructure, like adequate long-term care options.

Why deeming patients ‘socially admitted’ may be detrimental to their outcomes

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