Posted: 3/6/2017
Parkland social workers help reduce inappropriate ER, inpatient utilization
The patient tallied 71 visits to the ER over a six-month period. Although she was one of the most extreme “super-utilizers” of Parkland Health & Hospital System’s Emergency Department services last year, her case isn’t unique. In hospital ERs around the country, patients like her show up again and again, posing a financial burden on the nation’s strained healthcare resources.
According to a report by Kaiser Health News, super-utilizers account for just 5 percent of the U.S. population but consume almost 50 percent of healthcare spending. They may go to the ER when cold, hungry, drunk, suicidal or when they need a safe place to sleep or a medication refill. They may be homeless, have psychiatric or substance abuse issues, or struggle with chronic, complicated medical conditions. But most of their problems could be handled better elsewhere – in a primary care clinic, at a local shelter, drug rehabilitation program or food bank, for example.
Tackling the problem isn’t easy, but health systems like Parkland increasingly rely on social workers to find viable solutions for these patients. The healthcare social worker acts as a client advocate, educator, advisor and coordinator of care who helps find interventions designed to promote health, prevent disease and address barriers to access to healthcare.
According to the Bureau of Labor Statistics, there are more than 155,000 healthcare social workers in the U.S. They can be found in hospitals and nursing care facilities, outpatient centers and home health agencies, psychiatric and substance abuse clinics and even insurance companies. Nearly 10,000 healthcare social workers are employed in Texas and more than 2,000 in the Dallas-Fort Worth area. Celebrated each March, National Professional Social Work Month is an opportunity to learn more about the important contributions that social workers make to society.
Marilyn Callies, MBA, BSN, RN, Senior Vice President of Transitional and Post-Acute Services at Parkland says she and her team of care management specialists and social workers form the tip of the spear in the effort to reduce inappropriate use of medical services at Parkland. “Our goal is to help identify patients’ problems and find the resources they need. Ultimately, we want to help them have better health outcomes while eliminating avoidable hospital use,” she said.
Recently, Parkland created an ER Complex Case Committee to address the issue of ER super-utilizers. The multidisciplinary team includes nurses, physicians, psychiatry staff, social workers, financial services staff and care management leadership. The committee meets weekly to discuss patients who come to Parkland’s ER more than five times in 30 days. Each team member has a unique perspective on the patient’s needs. Working together, they determine what issues prompt these patients to return so frequently and develop effective interventions to reduce their ER visits while also providing better health outcomes for the patient.
“Is this person homeless? Drug-dependent? Without transportation to a clinic? Lacking family support? Unable to manage their medications? Once we understand the patient’s issues, we can work with other community agencies to make a plan with the patient and help them stick to it,” said Sheryl Abraham, LCSW, ER Complex Case Social Worker at Parkland.
Parkland partners with community-based organizations, non-profits, food pantries, shelters, home health agencies, hospice, assisted living and nursing home facilities to find solutions for patients needing resources beyond the acute care setting.
“These patients are the ones most in need,” Abraham added. “By asking ‘how can we best help you?’ we can pinpoint the resources they need and empower them to overcome their situation. It leads to more appropriate use of the ER and also helps patients achieve a better quality of life.”
Marcy Floyd, LMSW, Manager of Post-Acute Services at Parkland, helped launch a similar program at Parkland four years ago aimed at reducing inpatient length-of-stay. Called the Inpatient Complex Case Committee, it handles discharge planning for approximately 300 patients a year who have unique physical, social or psychiatric issues.
“We had one patient who we honestly thought might never be able to leave, but we advocated and persevered to find a solution for her,” Floyd said. “Helping patients like her transition out of the hospital can be a huge challenge, but everyone deserves to have someone advocate for them. We can’t ever stop trying or give up.”
“The other key component is getting patients involved and helping them take ownership, use the community resources available to them and access what they’re eligible for,” Floyd said. “We help motivate them to tap their own self-interest.”
Floyd admitted that working on difficult cases sometimes feels like pushing a boulder up a hill. “But,” she said, “I love that we care so much about these individuals and want to find the best solutions possible for them. If we don’t care for them, who will?”
“It’s so satisfying to have the chance to impact someone’s life forever,” Abraham said. “We help them have a better life. It’s why I love this work.”
And that patient who came to Parkland’s ER 71 times over a six-month period? Abraham and Floyd smile. She no longer uses the ER as the solution to the issues that arose from homelessness. The interdisciplinary team approach resulted in a post-acute care plan that helped this patient move to a boarding home and assume responsibility for the quality of her life.
“This woman has truly reconnected with hope and love,” Callies said. “Parkland’s team remains involved in her successes by maintaining ongoing communications with her through follow-up phone calls. If barriers for care are identified, the team provides prompt intervention to support successful outcomes. The patient now expresses happiness with her life and is excited about her future.”
To learn more about services at Parkland visit www.parklandhospital.com