In earlier studies it was found that the severity of patients' psychosocial problems was a significant predictor of length of stay (LOS). This current study compared predictors of LOS for samples of patients referred to social services in three large urban hospitals in June-October 2002 (n = 176) and 2006 (n = 147), and examined changes in patient characteristics and the nature of social work practice. A significant relationship between psychosocial severity and LOS was again found, confirming the important role that social services can potentially play in controlling hospital costs. Some significant changes were also found in the pattern of social work practice; this was generally in the direction of more community consultation and collaboration, suggesting a greater emphasis on multidisciplinary teamwork.

In an acute care hospital, a major performance indicator is patient length of stay. This study, in a large university teaching acute care hospital in Canada, examined the effect of psychosocial problems on length of stay, controlling for patient demographics and medical condition. Average days stay for Diagnostic Related Groups (DRGs) was used as a proxy variable for severity of medical condition, and the Person-in-Environment (PIE) classification system was used to measure psychosocial problems. Data were collected on a sample of 160 patients; 78 in psychiatry and 82 in medical/surgical wards. In a regression analysis, the severity of the patient's psychosocial problem was a more significant predictor of length of stay than the DRG variable. The identification of psychosocial problems and their severity add an important and complementary dimension to research into the effectiveness of social workers in reducing length of stay. Workers found clients had significantly more problems related to their social role functioning than problems in the environment.

The Cancer Nutrition Rehabilitation (CNR) program at the McGill University Health Centre is an interdisciplinary 8-week treatment program offering patients information, education, treatment, and support in areas such as diet, exercise, and rehabilitation, plus resources to address their psychosocial needs. The program social worker helps the patient and the patient’s family to cope with the illness, to problem-solve, and to obtain needed resources. Here, we present a description of these patients—demographics, medical diagnoses, and psychosocial needs as assessed by the Person-in-Environment standardized instrument—derived from the socialwork files of the 75 patients referred to social work in the period February 2007–December 2008. The reason most frequently reported for referral to social work was assistance with psychosocial problems. For 41.3% of the sample, these problems were assessed as high severity, and almost half the patients in the sample (47.8%) were assessed as having inadequate coping ability. Patient age was the most important demographic variable. Although seniors (63–94 years of age) were the least likely to have high-severity psychosocial problems, they were the most likely to have inadequate coping ability. That finding suggests that the CNR social worker, in addition to dealing with the instrumental, practical needs of cancer patients, is in a unique position to respond to their emotional difficulties in coping with their illness, and that health care professionals need to pay particular attention to the coping ability of elderly patients.

Data on excess length of stay (LOS)-the difference between actual LOS and target LOS for the medical problem-were analyzed for three acute care hospitals. For a sample of 2,642 cases, 29.2% of all hospital days were excess days for patients referred to social services. For a sample of 176 social service cases, a stepwise regression yielded two statistically significant predictors of LOS: (1) Medical problem (target LOS) and (2) severity of psychosocial problem (Person-in- Environment scale). The importance of psychosocial severity as a predictor of LOS has clear implications for the role social workers can play in making health care organizations more efficient.

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