Tammy David, R.N., is used to patients arriving on her hospital's doorstep with little but the clothes on their backs. Often, the emergency department staff have to cut off the clothes to treat the patient. Other times, the clothes are kept as evidence if the patient has been a victim of a crime. And sometimes the patient has been living on the street so long, his clothes are too far gone to salvage.

For the past 19 years, David has worked at Cleveland's MetroHealth Medical Center, the county hospital in a county where the poverty rate approaches 20 percent. MetroHealth did $133 million in charity care last year.

It always troubled her to see patients with virtually nothing to their names having to leave the hospital wearing hospital gowns. Then about 10 years ago, when David's stepfather died and her mother was going through his clothes, David had an epiphany.

"My mom was going to give them to the Salvation Army and I thought, 'Why can't we give them to the hospital?' "

That was the beginning of the Little Closet Shop, a neatly organized space at MetroHealth where clothes are distributed to patients who need something to wear when they're discharged.

It took about four months to get things rolling. David approached her supervisor Katie Carney, director of nursing, about finding a small space in the hospital where she could take donations. "I was worried it wouldn't come together because we couldn't find the right space," says Carney. "Space is always a luxury here."

But eventually, it did come together. A room was found and a department store donated racks from a line of clothes it was discontinuing.

David, who was single at the time, would come in on the weekends with her two children and her mother to set things up. She spread the word to co-workers with flyers and word of mouth. "I'm pretty social," she says. "I talk to everybody."

Her colleagues were skeptical at first. "They were all happy I started it, but they all said the same thing: 'It does take a lot of work. Are you really going to be able to keep this thing going?' " But pretty soon, the donations started rolling in.

"Tammy got an overwhelming response from staff to donate clothing," says Carney, who calls the service a godsend. "We have a number of areas that use it very frequently — inpatient units, nursing departments and emergency departments. Prior to this, unfortunately, if a patient didn't have anything — or have someone outside of the system to come in and bring them something — you'd see them go home in hospital pajama bottoms or a gown."

Staff can access the room if they have a patient in need. David also distributes clothing in bins at the rehab area and the Women, Infants, and Children program. "They go fast," she says.

One of David's recent clients was a homeless man who told her he had been living in his car for three to four months. He had been wearing the same clothes all that time. "I talked to him and told him what we did," says David. "I said, 'Come with me. Take whatever you need.' " At first he was hesitant, she says, but once she explained the program to him, he accepted the clothing.

"Everything that'd been donated stays here at Metro," she says. "It just provides these people with a little bit of dignity."

The need is especially dire in winter, when a thin coat in Cleveland's single-digit temperatures might just put a patient back in the hospital.

David's family members — her mom, kids, and her new husband — are still the Little Closet Shop's core volunteers, coming in to sort and fold for about four hours every other week. "I make them all come," she says. "I have a 14-year-old and a 16-year-old, and this is the real world. I think sometimes the kids forget how really fortunate they are."