Selby Sasha, Wang Dongmei, Murray Eoin, Lang Eddy
Medicine, University of Limerick, Limerick, IRL.
Alberta Health Services, University of Calgary, Calgary, CAN.
Cureus. 2018 Sep 4;10(9):e3247. doi: 10.7759/cureus.3247.
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.
引言
急诊科（ED）收到的社会工作（SW）转诊申请凸显了现有弱势群体支持系统的薄弱之处。SW人员在一些急诊科发挥着关键作用，但在多个辖区并未融入团队。我们的目标是通过描述城市急诊科地点的SW咨询模式，详细说明急诊科环境中对SW支持的需求。
方法
对通过四家急症护理医院网络进行的急诊科SW转诊进行为期三年的分析，这些医院服务于一个拥有120万居民的城市，SW人员的工作时间为上午8点至晚上10点。研究设计为描述性报告比例。感兴趣的描述指标是接受SW咨询的急诊科患者类型以及患者被转诊至SW部门的原因。
结果
在研究期间，共进行了46,970次SW咨询，占卡尔加里市急诊科572,804名就诊患者的8.02%，即每天通过急诊科向SW人员转诊42.9人次。女性家庭暴力咨询的发生率是男性的三倍（占转诊的6%）。然而，家庭暴力咨询对男性来说仍是一个突出问题（占1.9%）。按年龄组比较发现，75岁以上患者转诊的最常见原因是病情调整（15.3%）、出院计划（31.2%）和法律决策（23.9%）；75岁以上患者中有92.8%在SW咨询后被收治。30岁以下患者延迟转诊的原因是病情调整（12.2%）、出院计划（16.4%）和法律决策（1.4%）；30岁以下患者中有57.3%在咨询后被收治。成瘾/药物使用和无家可归在30岁以下人群中更为常见，分别占SW转诊的24.1%和15.4%，而在75岁以上人群中分别占转诊的1.6%和0.4%。
结论
在这些大型城市急诊科，对SW支持的需求既重大又复杂。然而，其对患者护理和资源利用的影响很大，数据表明SW整合可能对急诊科普遍有益。有必要进一步开展研究，以准确描述为实现最佳患者治疗效果和医院资源利用所需的SW数量和类型。
