**Background:** Emergency department (ED) visits in the US have grown faster than population growth, particularly at safety-net hospitals serving underinsured populations. Social determinants of health (SDoH) contribute to health inequities and repeated ED utilization. While there is growing interest in addressing SDoH from the ED, limited evidence exists on how multi-domain resource interventions impact ED utilization outcomes. This study evaluated a volunteer-led initiative providing medical and social resources at ED discharge and its association with revisit rates and follow-up adherence.
**Methods:** This retrospective cross-sectional study was conducted at a large county hospital in Houston, TX (~89,000 annual ED visits) between September 2017 and June 2018. Undergraduate volunteers (trained biannually in 8-hour sessions) delivered the intervention in lower-acuity treatment areas. Patients were offered a standardized educational intervention (medication review, follow-up appointment emphasis) and information on medical resources (prescription discount cards, pharmacy lists, primary care/dental clinics) and social resources (rent assistance, food programs, transportation subsidies). Follow-up phone calls were attempted one week post-discharge. Data were collected from electronic health records and standardized forms. Primary outcome was ED revisit frequency; secondary outcome was follow-up appointment adherence, both assessed at 30 and 90 days. Binomial logistic regression was used for analysis.
**Key Results:** Of 614 patients receiving the intervention, 494 were included after exclusions (104 <18 years, 7 pregnant, 9 missing data). Most patients were Latino/Hispanic (55.3%), female (55.3%), and 35.2% were primary Spanish speakers. Nearly half (49.4%) were enrolled in the county financial assistance program (FAP), 33.4% were uninsured, and 13.6% had insurance. A total of 413 patients (83.6%) requested at least one resource; 329 (66.6%) requested more than one. Volunteers contacted 158 patients (32%) for follow-up. Of contacted patients, 81 (51.3%) reported using a received resource. Overall, 76 patients (15.4%) returned to the ED within 30 days and 114 (23.1%) within 90 days. Patients receiving both medical and social resources had lower odds of 30-day ED revisit (OR 0.50, 95% CI 0.27–0.95). Those reporting resource use had lower odds of 90-day revisit (OR 0.46, 95% CI 0.24–0.92). Social resource provision was associated with higher odds of follow-up adherence (OR 4.75, 95% CI 1.49–15.20), as was medical resource provision (OR 2.56, 95% CI 1.05–6.25). Males had higher odds of 30-day (OR 1.76, 95% CI 1.07–2.88) and 90-day revisits (OR 1.91, 95% CI 1.25–2.91). FAP enrollment was associated with higher odds of 30-day revisit (OR 2.11, 95% CI 1.15–3.87). Spanish speakers had lower odds of revisit (OR 0.53, 95% CI 0.33–0.85) and higher odds of follow-up attendance. Hispanic/Latino patients had lower odds of 90-day revisit vs. Black patients (OR 0.52, 95% CI 0.33–0.83).
**Clinical Implications:** This study suggests that a volunteer-led, low-cost ED discharge intervention providing both medical and social resources may reduce short-term ED revisits and improve follow-up adherence in underserved populations. The findings support the feasibility of using trained volunteers as patient navigator proxies in resource-limited safety-net settings. The differential outcomes by gender, race/ethnicity, language, and insurance status highlight the need for targeted interventions addressing specific population risk factors. However, the single-site design, lack of a control group, and low follow-up rate (32%) limit causal inference and generalizability. Future research should examine implementation strategies, cost-effectiveness, and comparative effectiveness of in-person vs. non-individualized approaches.