ED management includes the history and physical examination, as reviewed. Adjuncts to care include use of vitamin supplements and food, dispensation of medications, updating of immunizations, and reviewing documentation of past medical care. Pregnancy status and potential for sexually transmitted diseases should be investigated in homeless women of childbearing age. Appropriate gynecologic care, prenatal care, or family planning services can thus be arranged. Once a diagnosis and treatment plan are defined, patients should be assessed for language barriers, literacy, and capacity to comply with routine care instructions, medical regimens, or follow-up. An old chart may indicate immunization status, forgotten or disregarded health problems, and the ability of homeless patients to follow up. A lower threshold for admission should be maintained for patients with an impaired ability to manage their own care. This decision is easily acceptable if one appreciates how the patient arrived at the condition in question and how difficult, if not impossible, outpatient care may be in certain circumstances. A multidisciplinary approach to care, including social workers and nursing, medical, and psychiatric staff, may offer the most supportive environment for homeless patients. Such compassionate care in the ED, using trained and motivated individuals, will ensure that patients receive the care they need, increase patients' satisfaction, and reduce the rate of return ED visits among frequent users.20
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