When social issues become medical emergencies: Prevalence and patient characteristics of social emergency admissions in internal medicine.

Abstract

Social Emergency Admissions (SEA) are unplanned hospitalisations due to acute social crises without medical indications. This study quantified and characterised SEA. We reviewed unplanned internal medicine admissions to 3 hospitals in Lucerne, Switzerland, in 2023. Admissions considered as SEA had ≥1 social stressor documented but no medical indication for hospitalisation. SEA were compared descriptively with other admissions. Of 445 reviewed cases, 39 (8.8 %) were SEAs, corresponding to 6.7 % of all unplanned internal medicine admissions via emergency department. SEA could be categorised into 3 clusters: informal caregiver breakdown (22; 56.4 %), isolation/environmental neglect (14; 35.9 %), failure of formal care structures (3; 7.7 %). SEA patients were older (median 84 [interquartile range 75-88.5] vs. 72 [56.25-82] years), stayed longer (6 [4-9] vs. 4 [2-7] days), and more often received professional home support (35.9 % vs. 7.9 %) and care from relatives (53.8 % vs. 10.6 %). They were also more frequently multimorbid (≥2 comorbidities: 82.1 % vs. 64.3 %) and showed higher prevalence of electrolyte disorders (41.0 % vs. 19.5 %), weight loss (20.5 % vs. 5.2 %), alcohol abuse (17.9 % vs. 2.7 %), and dementia (17.9 % vs. 3.9 %). This multicentre study provides the first quantitative assessment of SEA in internal medicine, with 6.7 % of unplanned admissions meeting a structured SEA definition and involving older, more multimorbid patients with longer hospital stays. SEA constitute a distinct subgroup of emergency admissions driven by identifiable social risk clusters rather than acute medical urgency.