Timeliness of injury care and housing status.

Background: Unhoused people have longer hospital lengths of stays than housed. This study examined if unhoused people have less timely injury care than housed.

Methods: We conducted a retrospective cohort study of adult injury encounters from January 2015 - December 2022 at the only level 1 trauma center in an urban county. We merged the trauma registry with a county-wide integrated dataset to reliably identify our primary exposure: housing status in the fiscal year of injury. The primary outcome was time to the operating room in hours. Secondary outcomes were emergency department (ED) length of stay in minutes and additional timeliness measures. Multivariable linear regression models with clustered standard errors estimated the association of housing status with each log-transformed outcome, adjusting for clinical and demographic covariates.

Results: Among 21,264 trauma encounters, 18.8 % (N = 4003) were in unhoused people. Unhoused and housed people had similar adjusted times to operating room (9.2 versus 9.9 h; adjusted geometric mean ratio 1.07 (95 %CI 0.97-1.19; p = 0.19). ED length of stay was 17 % longer for unhoused people compared to housed (381 versus 326 min); adjusted geometric mean ratio 1.17, 95 %CI 1.13-1.21; p < 0.001). There were no clinically significant differences in Emergency Medical Services (EMS) transport time, EMS scene time, time to venous thromboembolism prophylaxis, nor time to angiography by housing status.

Conclusions: Timeliness of injury care is similar between unhoused and housed people.