Preadmission Psychosocial Screening of Older Orthopedic Surgery Patients

Abstract

A preadmission social work intervention was evaluated for impact on length of hospital stay (LOS) and patient satisfaction. Psychosocial issues related to function and post-discharge needs were assessed at an exploratory level. A modified post-test only control group design was used. Study group patients were screened before hospitalization and offered services on admission. Control group patients received standard care. Study group patients were significantly more satisfied with services but impact on length of stay was not demonstrated with one possible exception. Post-operative complications were significantly related to longer LOS; however, unlike control group patients, study group patients with complications did not have significantly longer LOS. Women and those limited in preadmission physical function were most likely to report insufficient help after discharge. A more intensive preadmission intervention is recommended to improve impact on LOS and informal support system involvement, while future outcome studies would clarify the nature of service gaps and high risk groups.

Including Psychosocial Factors in Screening for Surgery: A Preliminary Literature Review from a Social Work Perspective

“…In summary and acknowledging the ranked quality and relevance of articles, four of the highly ranked articles emphasised the link between psychosocial issues, poorer treatment outcomes and longer hospital stays (Epstein et al, 1998;Preyde & Chapman, 2007;Shahmansouri et al, 2014;Spilsbury et al, 2007). This underscored the importance of these connections.…”

“…Reviewed articles emphasised that early and comprehensive screening is important, particularly for the socially vulnerable (de Jonge et al, 2000). Screening is required as a basis for addressing length of stay (de Jonge et al, 2000), it can inform discharge planning and community follow up (Oxlad et al, 2006;Preyde & Chapman, 2007), and it is a hallmark of a quality service (Epstein et al, 1998). It was noted that psychosocial screening should follow social work principles and seek to facilitate empathetic listening (Bennett, Legon, & Zilberfein, 1990;Oxlad et al, 2006;Preyde & Chapman, 2007).…”

“…With reference to timing, there were indications that screening should take place prior to hospital admission (Gorton, Jayanthi, Lepping, & Scriven, 2008), however in reality, the literature indicated that screening is mostly conducted on admission or post admission (within 3 days) (de Jonge et al, 2000;Epstein et al, 1998). Reviewed articles noted that for many patients, emotional, psychological and practical concerns are particularly pronounced on admission (Bennett et al, 1990), however the pre-surgical processes and procedures rarely accommodate such screening or responses to these concerns (Spilsbury et al, 2007).…”

“…Unfortunately in these settings nurses often have insufficient time to complete pre-admission tasks, despite such screening requiring considerable time and communication (Fraczyk & Godfrey, 2010). Acknowledging the clear overlap between the focus of psychosocial screening and social work skills (Bennett et al, 1990;de Jonge et al, 2000;Epstein et al, 1998), it would appear that the staffing model for such screening warrants further consideration.…”

“…The patient's post-surgery transition through the healthcare system can be enhanced by social worker intervention to identify psychosocial issues, which may in turn impact on the patient's length of stay, level of coping and readiness for discharge home. In this regard, some have suggested that social workers should also apply their skills to the pre-surgery context to improve services to patients and contribute to greater service efficiency (Epstein et al, 1998).…”