Emergency medical care of incarcerated patients: Opportunities for improvement and cost savings

Abstract

In the United States (US), the lifetime incidence of incarceration is 6.6%, exceeding that of any other nation. Compared to the general US population, incarcerated individuals are disproportionally affected by chronic health conditions, mental illness, and substance use disorders. Barriers to accessing medical care are common in correctional facilities. We sought to characterize the local incarcerated patient population and explore barriers to medical care in these patients. We conducted a retrospective, observational cohort study by reviewing the medical records of incarcerated patients presenting to the adult emergency department (ED) of a single academic, tertiary care facility with medical or psychiatric (med/psych) and trauma-related emergencies between January 2012 and December 2014. Data on demographics, medical complexity, trauma intentionality, and barriers to medical care were analyzed using descriptive statistics, unpaired student's t-test or one-way analysis of variance for continuous variables, and chi-square analysis or Fisher's exact test as appropriate. Trauma patients were younger with fewer medical comorbidities and were less likely to be admitted to the hospital than med/psych patients. 47.8% of injuries resulted from violence or were self-inflicted. Most trauma-related complaints were managed by the emergency medicine physician in the ED. While barriers to medical care were not correlated with hospital admission, 5.4% of med/psych and 2.9% of trauma patients reported barriers as a contributing factor to the ED encounter. Med/psych patients commonly reported a lack of access to medications, while trauma patients reported a delay in medical care. Trauma-related presentations were less medically complex than med/psych-related complaints. Medical management of most injuries required no hospital resources outside of the ED, indicating a

A Scoping Review of Current Social Emergency Medicine Research

“…We identified 11 relevant publications: eight observational studies 400 – 407 ; two interventional studies 408 , 409 ; and one commentary publication. 410 Of the observational studies, five (63%) publications centered on ED utilization after release from prison.…”

“… 410 Of the observational studies, five (63%) publications centered on ED utilization after release from prison. 400 , 403 – 405 , 407 Both interventional publications focused on models of care for recently released prisoners. Of all publications, three (38%) focused on pediatric populations.…”

Definition of patient complexity in adults: A narrative review

“…48 Finally, there was great heterogeneity across definitions of patient complexity, while some authors even wrote about patient complexity without providing any definition. [88][89][90][91][92][93][94][95][96][97][98] Developing and using a more standardized definition of patient complexity that can also help to identify complex patients in clinical practice may ease study comparison. However, it may not be achievable or desirable, since patient complexity is to a certain extent context-and practitioner-dependent.…”

Adult hospitalizations from immigration detention in Louisiana and Texas, 2015–2018

“…This does not include psychiatric disease since state prisons often triage psychiatric illness to internal psychiatric units. However, emergency department (ED) admission data from Tennessee and New York State show that 4% and 13% of presenting diagnoses were psychiatrically related [37,38] This is likely, however, due to differences in baseline co-morbidities between immigrant and local populations: Among non-immigrant patients who presented to ED from prisons, 35% have a comorbidity of hypertension, 16% have a comorbidity of coronary artery disease, 11% have a comorbidity of diabetes, and 45% have a comorbidity of psychiatric illness [38].…”