Emergency Department Experience with Novel Electronic Medical Record Order for Referral to Food Resources

The United States Department of Agriculture (USDA) defines food insecurity as “limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways”. Food insecurity is prevalent in the U.S., affecting 12.7% of the population in 2016. The impact of food insecurity can be pervasive and has been described by the World Health Organization as a key social determinant of health.

The prevalence of hunger and the impact of food insecurity in the emergency department (ED) is clinically important and likely underestimated. One study reported that 23.7% of ED patients reported hunger or food insecurity in the year prior, and nearly 18% of patients chose medicine over food during that same time period. Many of these patients reported the belief that this decision resulted in illness, ED visits, and hospitalization.

To address such issues, healthcare institutions reportedly are partnering with food resources for their patients. But if these services are to reach the patients, referrals must be initiated by staff or accessed directly by the patient/client. While our institution has partnered with the food bank Second Harvest Heartland since 2010, referrals from the ED were made infrequently. In 2015 a novel referral model was developed in the form of an electronic medical record (EMR) order by which ED providers could easily refer patients for food resources. Targeted education of the ED staff on food insecurity and instruction on the use of the EMR order was also performed.

The purpose of this study was to report the novel use of an integrated EMR order for food resources, and to describe our initial institutional referral patterns after focused education and implementation of the order.