Introduction   Social Work (SW) referrals made in the emergency department (ED) highlight   the weaknesses in the existing support system for vulnerable and   disadvantaged patients. SW personnel play a pivotal role in some EDs but are   not integrated into the team in several jurisdictions. Our objective was to   provide a detailed description of the need for SW support in the ED setting   by describing SW consultation patterns in an urban ED location. 

Methods A   three-year analysis of ED SW referrals made through a network of four acute   care hospitals serving a city population of 1.2 million inhabitants where   social workers operate from 8 a.m. to 10 p.m. The study design was   descriptive reporting proportions. The descriptors of interest were the types   of ED patients receiving SW consultations and the reasons for patient   referral to the SW Department. 

Results During the study period, there were   46,970 SW consultations, representing 8.02% of the 572,804 patients who   visited the ED across Calgary, yielding 42.9 referrals per day to social   workers through the ED. Consultations for domestic violence were three times   more prevalent for women (6% of referrals). However, domestic violence   consultations were still an active issue for men (1.9%). Comparisons by age   group yielded illness adjustments (15.3%), discharge planning (31.2%), and   legal decision making (23.9%) as the most common reasons for referral of   patients over 75 years old; 92.8% of patients over 75 years were admitted   following the SW consultation. Reasons for deferral of patients under 30   years of age were illness adjustments (12.2%), discharge planning (16.4 %),   and legal decision making (1.4%); 57.3% of patients under 30 years were   admitted following the consultation. Addiction/drug use and homelessness were   more common in those under the age of 30, comprising 24.1% and 15.4% of the   SW referrals, respectively, compared to 1.6% and 0.4% of referrals for those   over age 75, respectively. 

Conclusions The demand for SW support is   significant and complex in these large urban EDs. However, the impact on   patient care and resource use is substantial, and the data indicates that SW   integration may be of universal benefit to EDs. Further studies are warranted   to accurately characterize the amount and type of SW necessary for optimal   patient outcomes and hospital resource use.

Authors: Sasha Selby, Dongmei Wang, Eoin Murray, Eddy Lang