Sociodemographic and Clinical Profile of Homeless Patients Attending the Emergency Department of a Tertiary Care Centre in Rishikesh, Uttarakhand, India: A Prospective Observational Study.

Introduction Homeless individuals are a highly vulnerable population with complex medical and social needs. Emergency departments (EDs) often serve as the primary point of contact for healthcare for homeless persons in India, yet systematic data on their profile and outcomes from tertiary care settings remain limited. Methodology A prospective observational study was conducted in the emergency medicine department of a tertiary care centre in North India from July 2022 to December 2023 (18-month duration). All homeless patients aged over 18 years presenting to the emergency department and meeting inclusion criteria were enrolled. Sociodemographic data, clinical presentation, investigations, consultations and ED outcomes were recorded using a structured pro forma, and data were analysed using SPSS v23.0 (IBM Corp., Armonk, NY). Results Forty-eight homeless patients were enrolled in the study. The majority were men (93.8%), adults aged 31-60 years (52.1%) and from Uttarakhand (85.4%). Most patients (75%) were staying alone, and 81.2% were uninsured. The most common mode of arrival was ambulance (85.4%), with 66.7% referred from another healthcare facility. The most common presenting complaints were abdominal symptoms (22.9%), dyspnoea (18.8%) and trauma (16.7%). Chronic obstructive pulmonary disease (COPD) was the most common diagnosis (12.5%), followed by head injury (10.4%) and decompensated chronic liver disease (8.3%). Two-thirds of the patients (66.7%) were triaged to the red area. ED in-hospital mortality was 18.8%. The median ED length of stay was two days. Fourteen patients had ED revisits during the study period. Conclusions Homeless patients presenting to the ED are predominantly men and uninsured and arrive in critical condition via ambulance. They carry a high burden of chronic disease, present late in the course of illness and have substantially high in-ED mortality. Integrated care models, policy-level expansion of health coverage and dedicated ED protocols for homeless individuals are urgently needed in India.