Pilot project of social workers in emergency departments proving to have tremendous benefits to patients

The social work in emergency department pilot project at Horizon’s Saint John Regional Hospital has been a success thanks to the coordination and teamwork of many Horizon units and departments and community agencies. From left: Bev, registered social worker, Catherine, emergency department registered nurse, Jennifer, Patient Flow Coordinator and Hilary, registered social worker.

When patients enter the health care system, they may think their problems are insurmountable. A new pilot project in Horizon emergency departments is allowing registered social workers like Bev to help solve them.

Beverley has worked for more than 25 years in hospital and community settings, primarily with patients and families with complex medical needs and social histories.

Recently, she started working in a new environment: the Emergency Department (ED) at Horizon’s Saint John Regional Hospital (SJRH).

This role was created as part of a pilot project that sees social workers assess and support patients in EDs. This project is helping prevent social admissions (an acute hospital admission arising mainly because of unfulfilled social care needs), reduce emergency department visits and strengthening early co-ordination of social determinants of health to decrease the length of stay for admitted patients.

The initiative, championed by Horizon’s interim president and CEO Margaret Melanson, began at SJRH in January, and now has rolled out at Horizon’s The Moncton Hospital (TMH), Dr. Everett Chalmers Regional Hospital (DECRH) in Fredericton and Miramichi Regional Hospital (MRH). Since this time, more than 350 social admissions have been prevented.

From January to mid-August, Bev has had more than 700 referrals. She was joined by Hilary Neman Loveless who was completing part of her 450-hour advanced practicum placement in the ED, graduating with a Master of Social Work degree from St. Thomas University.

To initiate an intervention with social work, the ED team and Jennifer Bickford, Horizon’s patient flow coordinator for the Saint John area submit referrals to social work identified a holistic range of needs.

Sometimes patients need immediate support, such as medication, equipment or Medicare coverage, transportation to appointments and harm reduction support and detox referrals; other times, they need long-term support, such as support with applications for ALC, in-home long-term care or disability support applications, housing, community mental health or substance dependence treatment programs.

A major benefit of social work in the ED is the opportunity to connect with patients at the beginning of their health care journey, as many patients come to the emergency department for a crisis that may change the way they live, work and function in their community.

Often, the medical and community support needs of the patients she sees are complex — but social workers have the knowledge and skills to quickly assess and begin to engage them with the social support they need early in the day.

“The thing about coming to an emergency department is that it’s a crisis for that patient,” said Bev. “They need support very quickly.”

Social work’s efforts build upon existing partnerships between the ED and community agencies, deepening the understanding of emerging needs, care coordination, and timely access to resources to best support patient care have been positively received and effective from the outset of the pilot program.

This has resulted in many groups of people going above and beyond to support this program to create sustainable outcomes for patients, including – and starting with – Horizon staff, physicians and teams. 

Jan Murray, ED Nurse Manager, Victoria Crilley, ED Charge RN and the entire SJRH ED team, along with Melanie Polley, manger of Social Worker at SJRH, have been amazingly supportive of project, as has the Saint John Regional Hospital (SJRH) Foundation.

Tanya Cormier, the ED Office Coordinator has helped collect donations of reusable water bottles from the Irving Foundation and has sourced and organized a new storage area for clothing donations, while ED physicians and the Brighten Group contribute to replenishing the high volume of clothing items provided to vulnerable patients.

Something like a new cell phone may be the one thing that helps the patients through their health care journey, and thanks for a donation from Eric Lesser, nurse practitioner in the ED, and a large donation from Cook Aquaculture, social work can make that connection. Further, the social work team has secured funding from the SJRH Foundation to purchase new power cords and one-time phone cards to offer phones to patients who otherwise would be unreachable once they leave the ED.

To date, seven phones have been distributed, showing incredibly positive immediate impact, particularly for patient’s experiencing homelessness or support from Sexual Assault Nurse Examiner (SANE) team. *Learn more about how you can help this program at the end of this story.

“It has made a huge difference because it means that we can communicate with those patients after discharge. We can give them a reminder to get to the follow up appointments, we can help them with getting to their social assistance appointments,” Bev said. “We’re not seeing as many missed appointments and the patients feel connected.”

“That patient didn’t come back to the ED,” added Jennifer. “Everything was set-up for that patient, so it also protected our resources.”

As well, there are numerous partners in the communities that have provided inclusive and rapid response to meeting patient needs in their wellness journey. These include: local pharmacies, RECAP (Centre for Research, Education & Clinical Care of At-Risk Populations), Sophia Recovery Centre for Women, Elizabeth Fry Society of Saint John, Outflow Men’s Shelter, Housing Alternatives Inc., Port City Counselling Services, Coverdale Centre for Women, local church parishes, and River Stone Recovery Centre. The Department of Social Development and the New Brunswick Extra Mural Program have also been supportive health care partners. 

For alternate level of care (ALC) patients who need to be admitted because they can’t live independently at home any longer, having social work in the ED helps start the process to move to long-term care that first day, instead of weeks into admission.

“It’s opened the door that’s taking two or three weeks off of length of stay for that patient,” Bev said.

“It’s our goal that discharge begins at admission,” added Jennifer.

Sometimes, patients arrive at the ED with what they and their family believe are minor concerns, but they turn out to receive a life-changing diagnosis.

Having social workers in the ED means these patients can be referred to supportive interventions, such as the Cancer Patient Navigation Program on day one. Referrals that may have taken days are now assessed and initiated within hours – a “marvelous” improvement, Bev notes. And, if patients do need to be admitted, she’s able to help arrange supports to have a successful and sustainable discharge and hopefully decrease their chance of readmission.

Currently, Bev works Monday to Friday, 7 a.m. to 3 p.m. — a shift designed based on the patient population, as many people experiencing homelessness visit the ED over night.

In time, it is hoped the program will be expanded so that a social worker is available in the EDs at SJRH, DECRH, TMH and MRH 24/7.

*If you have a used cell phone you would like to donate to the Cell Phone Connection initiative, please contact Tanya Cormier at 648-6092 or tanya.cormier2@horizonnb.ca.