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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:
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:
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
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
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
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!