Date of Publication


Project Team

Dr. Christina Harlow, DNP, FNP-BC. Dr. Carol Buck-Rolland, Ed.D, APRN


Background & Purpose. Food insecurity (FI) affects 1 in 9 Vermonters (Feeding America, n.d.), and is associated with many poor health outcomes and healthcare expenses (Malecha et al., 2018). Research identifies emergency departments (EDs) as key settings to address FI in high-risk populations (Cullen et al., 2019), guiding this project to the ED of a Critical Access Hospital and Federally Qualified Health Center. This project intended to increase ED providers’ knowledge and utilization of food insecurity screening (FIS), use of FI billing code Z59.4, and subsequent referral to the Community Health Team (CHT). Specific aims included: identify existing facility resources, develop and deliver provider education, and collect and analyze data on knowledge, coding, and referral, pre and post-intervention.

Methods. A Continuing Medical Education (CME) presentation was developed and delivered to facility providers; participants were surveyed by Likert scale prior and following. The ED electronic medical record (EMR) was queried for Z59.4 and CHT referrals including this code or mention of FI, for the 4 weeks before and after.

Results. A 150% increase in provider’s comfort using a preferred method of FIS, 100% increase in value for coding FI, and 16.7% increases for confidence referring FI patients, and knowledge of FI resources, were seen. No increases in use of FI coding or associated CHT referral.

Conclusions. Provider education effectively increased knowledge around FIS, coding, and referring. Recommendations for future projects to focus on increasing provider application of this knowledge to practice.

Keywords. Food insecurity/screening, emergency department


Cullen, D., Woodford, A., & Fein, J. (2019). Food for Thought: A Randomized Trial of Food Insecurity Screening in the Emergency Department. Academic Pediatrics, 19(6), 646–651.

Malecha, P. W., Williams, J. H., Kunzler, N. M., Goldfrank, L. R., Alter, H. J., & Doran, K. M. (2018). Material Needs of Emergency Department Patients: A Systematic Review. Academic Emergency Medicine, 25(3), 330–359.

Vermont | Feeding America. (n.d.). Retrieved February 28, 2021, from

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