As social workers in St Vincent’s mental health acute inpatient unit, Loren Urzia and Meg Buck work with some of the community’s most marginalised people.
‘Our clients experience a variety of psychosocial issues including homelessness, poverty, social isolation, family violence, sexual assault and drug and alcohol issues,’ Loren says. ‘Our job as social workers on an inpatient unit is to address those issues and ensure that clients are safe for discharge.’
However Loren, Meg and their colleagues often felt under the pump in their role and began looking at how their work processes impact the patient journey and how they could streamline discharge planning.
‘As a team we wanted to create more capacity in the ward so that consumers waiting to access care in the community and in the emergency department could be accommodated without delay,’ Meg says.
‘What we found was that there was no standardised process for screening patients. After reviewing three months of files we found that only 17 per cent of clients had been contacted by Social Work. We also found that the average length of stay was 28 days.’
The team has implemented a screening tool that ensures that all patients are now reviewed by social work as soon as possible after admission and are screened for any barriers to discharge. These barriers are clearly identified and a plan is developed to manage the issues.
‘Before we implemented the screening tool, the way that social workers would receive a referral was via ward round or from a doctor,’ Loren says. ‘Doctors would ask for our help addressing an issue so that the patient can be discharged. Doctors were seen as the decision makers, and we waiting for direction, rather than being proactive.’
‘Maybe doctors didn’t fully understand the role that social work can play in identifying barriers to discharge,’ Loren says. ‘A doctor’s primary concern would have been medications or treatment, as opposed to looking at the social aspect.’
‘Since we implemented the screening tool, we have been able to see all patients between day one and day three of admission,’ Meg says. ‘Social workers can now identify the barriers to discharge themselves and start working straight away.’
The organisation has benefited as it is now easier to predict discharge, reducing length of stay and creating capacity to accommodate the patients with deteriorating mental health status in the community and emergency department.
It is abundantly clear that the screening tool is improving client outcomes. Client needs are being addressed earlier and they can be reassured that they are getting support they require.
The evidence shows that the new process has also contributed towards reducing length of stay, from 28 days to 9.4 days. Now clients are able to minimise the time spent as an inpatient and resume their lives without delay.
‘Before the screening tool was implemented, social workers felt overwhelmed all the time, because they were being bombarded last minute, but now they have a plan and feel they are in control,’ Meg says.