Elsevier

The Lancet

Volume 345, Issue 8958, 6 May 1995, Pages 1131-1134
The Lancet

A randomised trial of compassionate care for the homeless in an emergency department

https://doi.org/10.1016/S0140-6736(95)90975-3Get rights and content

Abstract

Homeless adults often visit emergency departments and often leave dissatisfied. We tested whether compassionate care, by improving patient satisfaction, can alter subsequent use of emergency services. We identified 133 consecutive homeless adults visiting one inner-city emergency department who were not acutely psychotic, extremely intoxicated, unable to speak English, or medically unstable. Half were randomly assigned to receive compassionate contact from trained volunteers. All patients otherwise had usual care and were followed for repeat visits to emergency departments. We found that rates of use were high, with patients making an average of seven visits a year (0·60 per month). More than a third of all patients made two or more visits within two days of each other. The average number of visits per month after intervention was significantly lower for patients who received compassionate care (0·43 vs 0·65, p=0·018). Analyses adjusting for each patient's previous rate of use confirmed that compassionate care led to a one third reduction in the number of return visits within one month (95% Cl 14 to 40%). Compassionate management of selected homeless adults decreases repeat visits to the emergency department. One explanation is that patients tend to return frequently until they are satisifed with their treatment.

References (26)

  • Wc Watson et al.

    Health care abuse

    Can Med Assoc J

    (1994)
  • Da Redelmeier et al.

    Understanding patients' decisions: cognitive and emotional perspectives

    JAMA

    (1993)
  • Cited by (87)

    • Communication skills in pain medicine

      2022, Anaesthesia and Intensive Care Medicine
    • Top 10 presenting diagnoses of homeless veterans seeking care at emergency departments

      2021, American Journal of Emergency Medicine
      Citation Excerpt :

      Several older studies in the U.S. found that some unique case management-like models have been promising. For example, one randomized controlled trial found that “compassionate care” led to reduced ED use compared to treatment-as-usual, presumably because of increased satisfaction with treatment [48]. Another randomized controlled trial found that patients who were enrolled in a transitional housing and case management program had greater reductions in ED visits and hospitalization days than treatment-as-usual [49].

    • The Neuroscience of Happiness and Well-Being: What Brain Findings from Optimism and Compassion Reveal

      2019, Child and Adolescent Psychiatric Clinics of North America
      Citation Excerpt :

      Compassionate care is a tenet of major medical organizations.51,52 Compassion in health care decreases use of emergency department services53 and lowers spending on diagnostic tests,54 and may have its greatest cost-saving potential in reducing staff burnout. Psychotherapists and health care workers with higher self-compassion report less burnout.55,56

    View all citing articles on Scopus
    View full text