A homeless man, middle-aged and gray, lies in a hospital bed at UC San Diego Health’s emergency room in Hillcrest, the odor of alcohol hanging heavy in the air. He arrived by ambulance. He wants help, though just a few days earlier he had left a detox program before its conclusion.
“This patient is part of a population we see regularly in the Emergency Department that often faces multiple health issues compounded by mental illness, substance abuse and homelessness,” said Brooke Anarde, social worker at UC San Diego Health.
Anarde adds that such high risk patients overcrowd emergency departments and drain resources if not addressed in a collaborative and comprehensive way. In an effort to prevent the constant revolving door that brings these patients to emergency rooms, UC San Diego Health hired three emergency department social workers last year. The social workers serve in Emergency Departments at both the Hillcrest and La Jolla campuses and are part of an overall mission to decrease readmissions and length of stay by establishing a bridge for high-risk patients to vital community services in San Diego County.
“Our emergency services medical team is dedicated to providing the highest quality of health care, but there are also significant psychosocial issues that need to be addressed with these patients - that’s where the social worker’s role is critical,” said Anarde.
Anarde and her counterparts work with high risk patients to determine the best fit with community resources, such as detox centers, emergency shelters, crisis houses and in-home support services. The Emergency Department social workers also partner with numerous community providers serving the same population, including the Psychiatric Emergency Response Team, the Homeless Outreach Team and the Resource Access Program.
“A patient who is repeatedly visiting the Emergency Department has several complex needs that are not being met,” said Anarde. “From my experience, the solution lies in partnering with the individual in a self-directed and goal-oriented way to better link him or her with appropriate community resources corresponding to health, mental health, social and emotional needs.”
UC San Diego Health Emergency Department social workers see more than 300 patients a month, Anarde said, directly placing several each day into community programs.
The system is a constant work-in-progress, continually refined and improved. Anarde said that Emergency Department staff have been incredibly supportive of her team’s role and have noted a difference in patient work flow and outcomes with social workers added to the team.
“The effort to help this patient demographic is a national movement,” said
James Dunford, MD, physician in the Department of Emergency Medicine at UC San Diego Health. “Addressing this issue with more resources, like social workers embedded in the Emergency Department, provides a benchmark for higher quality of care, a reduction in emergency room visits and a significant economic savings for taxpayers.”
For the homeless man from the detox center, Anarde said the goal of the Emergency Department social worker is to quickly build rapport with him, express empathy, promote autonomy and self-determination, conduct a bio-psychosocial needs assessment, evaluate readiness to change, provide psycho education and, when indicated, refer him directly to services such as housing, outpatient psychiatry, primary care or substance abuse treatment.
“Once a patient arrives to the Emergency Department, we have a short window of time to work with them and try to utilize life-saving resources in the community,” said Anarde. “When it all aligns, the root of the problem is addressed, we see success and it is very rewarding. However, when the same patient comes back a few days later, it can be very frustrating. In those cases, I try to think of it as planting seeds with the patient, and from the provider perspective, as an area for systemic improvement.
“Our team knows we are providing a valuable resource to help those struggling in San Diego County get their needs met in a more sustainable way and to improve the structure of emergency departments.”
Learn about other efforts UC San Diego Health is leading to address high-risk patients:
Emergency Department Community Placement Project (EDCCPP)