ER physician's project uses donated cellphones to connect vulnerable with ongoing medical care

For years, Dr. Andrea Somers has seen patients come to the hospital emergency department because they weren't able to attend followup appointments.

She remembers one man who came to the ER with his wrist in a cast "that was not supportive or doing anything" and in a lot of pain.

When she asked why he didn't follow up with a doctor, he said his housing situation changed, he moved and he didn't have a cellphone. So he came to the ER for help.

"If you don't have a phone and you don't have stable housing where someone can contact you or leave a message, you're stuck. So what do you do? You go back to the social safety net, which is the emergency department, and you seek help there," said Somers, who is an emergency physician at Toronto's University Health Network (UHN).

Patients who return to the nearest emergency department because they're unable to get the followup care they need is not a new phenomenon.

But with the wider use of virtual care implemented during the COVID-19 pandemic, Somerssaid she was motivated to help.

She created a projectthat provides donated prepaid cellphones to those who are homeless, struggling with mental health or substance use, or socially isolated, in hopes of getting people followup care instead of goingto the ER.

Since the project launched almost three years ago, early data shows the cellphones have helped some individuals avoid ER visits and receive the care they need.

"Providing a phone to these people[is a] very practical device for improving the continuity of their care, which reduces their ER visits," Dr. Howard Ovens, a staff emergency physician at Toronto's Mount Sinai Hospital and a member of the Canadian Association of Emergency Physicians (CAEP) public affairs committee, said of the project.

Phone costs a fraction of ER visit

The need to connect vulnerable patients with followup care outside of the ER existed long before the pandemic, Somers said.

Those who are experiencing homelessness "often live in conditions that adversely affect their overall short- and long-term health," according to the non-profit and non-partisan Canadian Observatory on Homelessness.

The organization also saidthat "being unhoused makes it difficult, and in some cases impossible, to access general health-care services" for several reasons, including not having a health card or access to a phone.

Of those visiting the emergency departments at the UHN, anaverage of one in 20 patients lacks an active phone number, according to the UHN Foundation.

"There's so many ways now that not having a phone disadvantages a person," Somers said.

Shelaunched Phone Connectin July 2020, after she and colleagues struggled to share COVID-19 test results or get ahold of patients as part of contact tracing.

More than 450 people have now received a phone through the grassroots project, which primarilyruns out of St. Michael's Hospital in downtown Toronto.

The donated phoneshave helped people connect with addictioncounsellors, family doctors and other specialists, said Somers, who manages the projecton top of her role as an emergency physician.

Money for the project comes from private donors andresearch funding, she said, noting that monthly bills are just $5.49 well below the cost of a single visit to the ER.

"We've been able to notify people that they have lung cancer and connect them to an outpatient clinic. If they didn't have a phone, they wouldn't get that message," she said, adding that the projectis still accepting phone donations.

But Somers said where she also sees success is in the reduction of emergency visits.

The preliminary data has not been peer-reviewed and has been submitted to CAEP for review.

It shows that 68 patients seen at St. Michael's Hospital who received a cellphone were able to avoid on average one emergency room visit over a three-month period, according to data compiled by Somers and colleagues.

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They believe that's because for some of those patients, the phone was also paired with access to an outreach worker.

Somers saidthe phones are also helping people access followup care and that they're seeing "better attendance at scheduled followup appointments."

"We have lots of wonderful programs set up. It's a matter of being able to access them without coming through the ER," she added.

'I think it's a fantastic first step'

Brian Cleary, a formerly homeless activist working on homelessness in Toronto, says having a cellphone is essential.

"In my own experience anecdotally and universally, I think those are two really big things:cellphone access and access to a primary care physician. I think it doesn't get more basic or important than that," he said.

"It's sadly lacking in the support andshelter system."

Clearysaidthat much more has to be done to help those in need of adequate housing or other social support.

"The way we treat our poorest in society is horrendous right now. It's absolutely horrendous, and we have to start asking some hard questions about what we want to be as a city, a province and as a country," he said.

Dr. Louis Francescutti, an emergency physician at Edmonton's Royal Alexandra Hospital and a professor in the University of Alberta's public health department, saidSomers's projectis an "innovative idea to connect" individuals to followup care.

"I think it's a fantastic first step, but we need to take it much further than that," he said, referring to housing and other supports, such as helping vulnerable individualsacquire identification.

Francescutti saidhelping people beyond the ER was the motivation behind a pilot project in Edmonton that he helped get off the ground.

The Bridge Healing Transitional Accommodation Program will provide people without a home a safe place to recover from illness or injury following their hospital visit.The 36-bed project is set to open this month with 12 beds, followed by another 24 beds in May.

"Hopefully down the road one day, the patient doesn't even have to go to the emergency. They can just walk right up to one of these buildings, knock on the door ... and then bypass an ambulance ride and bypass an emergency visit as well," he said. "That's the ultimate dream that we have."

Somerssaid she hopes the Ontario governmenttakes on the cellphone project and adopts it more widely, because from what she's heard from those who have received a phone, it's been a life-changer.

"It's not a panacea in terms of how we're going to solve emergency department crowding. It's so multifactorial, obviously," she said.

"But if we can eliminate the occasional unnecessary visit or enable people to be self-efficacious and make direct connections, that would be great."