Catholic Health East : Best Practices
Catholic Health East
Best Practice Narrative

RHC: Pittsburgh Mercy Health System
1400 Locust Street
Pittsburgh, PA 15219

Category:
New Delivery Models

Contact: James S. Withers, M.D.
Title: Medical Director, OSN
E-mail: Jwithers@mercy.pmhs.org
Fax: (412) 232-3726
Phone: (412) 232-5739

Description of the Best Practice: Operation Safety Net
Operation Safety Net is an innovative street medical outreach program for the unsheltered homeless of Pittsburgh. OSN brings medical, emotional support and coordinated care to the unsheltered homeless population. By working "from the street up", barriers and prejudice are systematically broken down and a caring relationship is developed. The medical care provided includes attending wounds, psychiatric illness, upper respiratory illnesses, and follow-up to chronic diseases such as diabetes, hypertension and cancer. A wide range of medical problems treated are in advanced stages due to neglect. Prevention measures on the streets include prenatal care, Tuberculosis and AIDS testing, foot care and protection from the environment. Since OSN began in 1992, there have been no deaths due to freezing, despite a substantial number of below zero days every winter.

Implementation
James S. Withers, M.D, founded operation Safety Net in 1992. In an initial six-month study of 114 homeless individuals living on the streets of Pittsburgh, Dr. Withers found many veterans and minorities without regular physicians; few who used the free clinics and all who were extremely wary of traditional medical systems. As a result, their medical needs were not being addressed, and they were dying in the streets. Now operating at fourteen clinical teams, the teams travel by foot and make "street rounds" to the unsheltered homeless in the city streets, alleys, river banks and abandoned buildings as well as deliver care in a dedicated medical van.

Time Frame
Since 1992 OSN has grown from the initial team to over fourteen clinical teams consisting of volunteer physicians, registered nurses and other health professionals along with formerly homeless outreach staff.

Financial Profile
OSN is dependent upon the generosity of local and private foundation supporters. Gifts of sleeping bags, socks, hats and gloves as well as monetary support are needed and very welcomed. Operation Safety Net is a tax-exempt charity program. OSN operates with a total annual budget of $250,000.

Outcome
The OSN model has significant implications for homeless health care access, medical education and volunteer opportunities. OSN has developed a typology of outcomes and behaviors as a means of tracking the status of clients, both clinically and in terms of their own independence and self-esteem. To facilitate care coordination, a computerized database known as SAFENET was developed. This database tracks all interactions between the street teams and the homeless and is a useful tool for case management. Physician training is an integral part of OSN with resident rotations established as part of the curriculum. OSN has received attention by the media and health care leadership organizations including 20 local and national awards.

Best Practice Narrative is limited to a one page summary.
Supporting data is limited to one page.