social emergency medicine

In Your Patient’s Neighborhood

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Where you live is a significant social determinant of health that impacts health and emergency care. In this episode, Dr. Kim Bambach (Assistant Professor of EM) interviews Dr. Amogh Krishnagiri (PGY-3 Chief Resident) about how built spaces and the connections they create ultimately influence health. From transportation access and food availability to education, housing stability, and local resources, a patient’s built environment directly affects their ability to follow up, fill prescriptions, and heal.

Key Learning Points:

  1. A neighborhood is more than a built location
    • It reflects the social connections, infrastructure, and resources that shape health outcomes.
  2. Social determinants of health impact emergency care
    • Transportation, food access, housing stability, income, and education all directly affect whether patients can follow through on ED discharge plans.
  3. Consider what’s in your patient’s neighborhood
    • Not all neighborhoods offer equal access to pharmacies, clinics, grocery stores, or safe transit. Expecting identical follow-up success across different environments is unrealistic.
  4. Transportation is often overlooked
    • If patients cannot physically get to appointments, pharmacies, or community resources, the plan fails.
  5. Take the time to make a safe discharge
    • Safe discharge planning requires feasibility, not just medical accuracy. A brief conversation about barriers can prevent bounce backs and unnecessary admissions.
  6. Connect to your community resources
    • Emergency physicians are uniquely positioned to connect patients to community resources.
    • Get to know the resources in your community and your ED social worker.

Bottom Line:
Understanding your patient’s neighborhood — especially their access to transportation and community resources — is essential to creating discharge plans that are safe, realistic, and truly effective.

Resources:

  1. Close.City
  2. Columbus Street Card
  3. Central Ohio Area Agency on Aging
  4. Columbus Metropolitan Library
  5. Ohio Domestic Violence Network
  6. Columbus Food Pantries

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SDoH: Caring for the Deaf and Hearing Impaired

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Hearing impairment is a significant social determinant of health that often impacts emergency department care. In this episode, Dr. Kim Bambach (Assistant Professor of EM) interviews Dr. Sophie Bolaños (PGY-2) about practical approaches to improve care for deaf and hearing-impaired patients in the ED. From understanding barriers to effective communication to leveraging local resources, this discussion provides actionable insights for creating a more inclusive and supportive care environment.

Guests: Sophie Bolaños, MD
Host: Kim Bambach, MD
Editors: Kim Bambach, MD and Chris San Miguel, MD

Key Learning Points:

  1. Understanding Hearing Impairment:
    • Over 1.5 billion people worldwide are deaf or hard of hearing, including 33 million children.
    • By 2050, one in ten people globally will have disabling hearing loss.
    • Hearing impairment intersects with other social determinants like unemployment, homelessness, and mental health challenges.
  2. Barriers to Care in the ED:
    • Communication challenges due to the need for ASL interpreters or clear communication methods.
    • Bias and frustration among clinicians unfamiliar with deaf culture or communication techniques.
    • Practical challenges such as non-functional nurse call buttons for hearing-impaired patients.
  3. Actionable Solutions:
    • Utilize an ASL translator even if the patient can read English or lip-read.
    • Stock audio amplifiers or use stethoscopes to enhance communication with hard-of-hearing patients.
    • Use clear masks to facilitate lip-reading.
    • Learn basic ASL signs, like the sign for “doctor,” and your last name to establish rapport while waiting for interpreters.
    • Maintain visual accessibility by keeping curtains open when privacy isn’t an issue.
  4. Community Resources:
    • Deaf Services Center (Columbus, OH): Offers ASL classes, advocacy, and peer support.
    • Ohio Relay: Provides a free service to facilitate phone calls for deaf and hearing-impaired individuals, supporting communication in English and Spanish.

Bottom Line:
Caring for deaf and hearing-impaired patients requires empathy, awareness, and resourcefulness. Clinicians should strive to minimize barriers and biases while leveraging available tools and resources to provide equitable care.

Resources to Learn More:

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