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Social workers cut nonemergent visits 45%
Registration times slashed, elopement rate cut
By locating a social worker in a hospital ED to help members overcome barriers to primary care, Horizon NJ Health, a West Trenton, NJ-based managed care organization, was able to decrease ED visits by 45% among its members who had a face-to-face conversation with the social worker. The 12-month pilot program at Newark Beth Israel Medical Center, a large facility (86,000 annual ED visits) in West Orange, NJ, was deemed so successful that Horizon NJ Health has maintained it for three years and has expanded it by adding social workers to five more EDs.
Having a social worker in the ED is not all that unusual; in fact, the department already had a social worker, says Thomas Michalowski, MBA, RN, director of patient care for the Beth Israel ED, What was different about this one was the role she played.
"We had a social worker that meets with victims of domestic violence, child abuse, and assault, counsels the homeless, and so forth," he explains. This social worker, however, only meets with patients enrolled in the Horizon NJ Health plan. "If they require follow-up care, rather than coming back here, she hooks them up with an appropriate physician in the network to get the care they need," Michalowski adds.
The statistics compared ED visits by members enrolled in the Medicaid managed care plan with Horizon NJ Health, explains Pamela Persichilli, RNC, manager of clinical services and utilization management for Horizon NJ Health. The health plan embarked on the pilot project after a data analysis showed that a large number of members were using the ED for primary care purposes, such as treatment for sore throats and earaches, Persichilli says. "When somebody comes in with a minor ailment, such as a sore throat, they tie up the staff and take up the bed for someone who needs to be seen urgently," she says.
Social workers check census
The social workers keep tabs on the ED census, so they can identify any Horizon NJ members who present to the department. After the members are treated, the social worker asks to talk with them and conducts a brief assessment to determine the barriers that kept the members from seeking care from a primary care physician.
The social workers update telephone numbers, addresses, and family members to contact in case of an emergency. They have a wireless computer and cell phones, which give them the tools they need to access the member's coverage and to find out and, if necessary, to change the primary care physician to whom the member was assigned at enrollment.
The social workers see all members who were discharged from the ED and who don't refuse the interaction. "We don't interfere with the hospital's operation or the treatment team," says Persichilli. "We are absolutely respectful of EMTALA and don't interfere with the patient being seen; we don't turn anybody away from the emergency department."
Michalowski agrees the social workers have been unobtrusive. "The program was designed not to affect flow; [Horizon NJ Health] didn't want to be perceived as interfering," he says. "We deliver our care, and she goes up to the patients after that."
There really was no need for the staff to adapt to the presence of the social worker, he continues. "I invited the social worker here to several staff meetings before the program started to let folks know what she'd be doing," he notes. "Sometimes a staff member will call her if they notice they have one of their patients, but normally the social worker just goes through our census."
Before implementing the program with any hospital, Horizon NJ Health conducts a claims analysis to identify the times during the day when the most members visit the ED. "The social workers staff the EDs during the times when there are the most visits among our members," Persichilli says.
For instance, peak hours for member visits are 11 a.m. to 7 p.m. at one hospital, but are 2 p.m. to 10 p.m. for another hospital in another part of the state. The social workers are off during the days of the week when the volume tends to be lowest. Many work on Saturday and Sunday because those are some of the busiest days in the ED.
The program does not affect the ED budget at all, notes Michalowski, as the social workers are paid by the health plan. "We just set her up with a small office area," he says. "The program is offered more as a benefit for their members; it cuts down the numbers of their patients who come to a busy ED and get caught in the system, and hooks them up with a physician rather than seeking primary care in the ED."
For more information on social workers in the ED, contact: