Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay

Abstract

BackgroundLong-stay patients in acute hospitals commonly present with complex psychosocial needs and use high levels of hospital resources.ObjectiveTo determine whether a specialist social worker-led model of care was associated with a reduction in length of stay for medically stable patients with complex psychosocial needs who were at risk of long stay, and to determine the economic value of this model relative to the decision makers’ willingness to pay for bed days released.DesignA prospective, matched cohort study with historical controls.SettingA large, tertiary teaching and referral hospital in metropolitan Southeast Queensland, Australia.MethodsLength of hospital stay for a cohort of patients seen under the specialist social worker-led model of care was compared with a matched control group of patients admitted to the hospital prior to the introduction of the new model of care using a multistate model with the social worker model of care as an intermediate event. Costs associated with the model of care were calculated and an estimate of the ‘cost per bed day’ was produced.ResultsThe model of care reduced mean length of stay by 33 days. This translated to 9999 bed days released over 12 months. The cost to achieve this was estimated to be $A229 000 over 12 months. The cost per bed day released was $23, which is below estimates of hospital decision makers’ willingness to pay for a bed day to be released for an alternate use.ConclusionsThe specialist social worker-led model of care was associated with a reduced length of stay at a relatively low cost. This is likely to represent a cost-effective use of hospital resources. The limitations of our historic control cohort selection mean that results should be interpreted with caution. Further research is needed to confirm these findings.

Multi-Disciplinary Discharge Coordination Team to Overcome Discharge Barriers and Address the Risk of Delayed Discharges

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Getting Unstuck: Challenges and Opportunities in Caring for Patients Experiencing Prolonged Hospitalization While Stable for Discharge

“…[27][28][29][30] Hospital systems may also use local historical data to identify common risk factors in their patient populations. 31 Tracking over time can identify trends and opportunities for future improvement.…”

Impact of psychiatric social workers on length of stay in psychiatric emergency service

“…How social workers can contribute to timely assessment and reduce LOS has been studied in a variety of health care settings. A social worker initiative decreased LOS for patients at risk of long duration of stay in an inpatient hospital setting, 2 and the addition of mental health social workers to a pediatric ED has also reduced LOS 3 . However, few studies have examined the value of social workers in a full‐range psychiatry ED, and we seek to demonstrate that they can offer much valuable assistance in patient evaluation, leading to reduced LOS.…”