Social work in the emergency department
A social work presence in the emergency department (ED) is critical to the effectiveness of the case management process. Patients and families are often at their most vulnerable while in the ED, and social work can play a vital role in assisting them during a difficult time. Crisis counseling and intervention for the patient and family in the ED is one of many functions the ED social worker can perform.
When considering the roles and functions for your ED social workers, review the list below. You might want to add to, or delete from, this list:
- issues of child abuse and neglect;
- issues of domestic violence, elder abuse, sexual assault, institutional abuse;
- counseling in response to death, trauma, accidents, injuries;
- crisis intervention;
- legal concerns (guardianships).
There will be occasions in which the nurse case manager and social worker will need to work collaboratively on a case and/or specific issues. Examples of these might include:
- coordination / facilitation of care for discharged patients;
- transportation for discharges or transfers;
- assistance with obtaining medications;
- patient education e.g. reinforcement regarding follow-up with medical; appointments, medication adherence, medical regimen;
- crisis intervention needed for patient / family having difficulty coping with illness, family dysfunction, trauma, death, accidents, injuries, substance abuse;
- referrals to home care, nursing home, or other community resources.
Like any program, your ED case management program should be evaluated and re-evaluated on a regular basis. (For an example of metrics for evaluating success, see box, below)
Metrics to be included in your evaluation are: Decrease in in-patient admission denials Review appropriateness of admission before patient is registered for admission Promote accurate documentation Discuss treatment and discharge plan with MD Conduct physician education including community resources and other options Reduce readmissions Review patients in the ED who have been discharged within 30 days or less Consider alternatives to readmission with the physician Watch for patterns by admit source and MD Reduction in in-patient length of stay Initiation of the case management plan and discharge plan while patient still in ED Earlier intervention equals quicker progression of care and earlier discharge Optimize the time the patient spends in the ED by initiating treatment Facilitate diagnostic testing Patient satisfaction Keep the patient informed Expedite tests and procedures Information gathering by the ED case manager and/or social worker will be perceived as "caring" by the patient and family Physician satisfaction Notify the primary care provider that their patient is in the ED and/or admitted Decrease in number of 'high utilization' patient visits to the ED Develop a plan to break patient pattern Accept what you cannot change Decrease in ED length of stay Anticipate ED discharges Meet patient's family, friends or caregivers early in ED stay Identify and communicate with community resources in place and/or available to the patient Make social work referrals |
Other issues to consider
Implementation should include regular meetings with key stakeholders, particularly the physician and nursing leaders in the ED. Others to consider as stakeholders would include administrators, finance, home care and nursing homes that you work closely with.
Staffing the ED with social worker and nurse case managers should mean coverage at the peak volume times. Many hospitals are looking at 24/7 models. If you are unable to afford that volume of staffing, then peak times may work for you. Also consider staggering the nurse case manager and social worker hours to allow for more coverage time. For example, the social worker might work from 8 a.m. to 4 p.m., while the case manager might work from noon to 8 p.m.
Whatever hours you can afford to cover, be sure that you do not neglect this vital area of the hospital. Remember to consider ED case management as a necessary and vital component of your case management department!
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