Q&A: Case managers and social workers in the emergency department
Q: Do you have any advice for how a case manager and a social worker can best work together in an emergency department setting?
A: Every day, a case manager and social worker starts off with a list. Their goal is to get through as much of the list as possible by the end of the day. However, changes throughout the day create the need to triage and prioritize. In each setting, case managers and social workers must develop priorities for the day to ensure that critical needs are identified and resolved.
Supporting capacity and cost/reimbursement are key to a successful day in the life of case managers and social workers. To manage capacity, discharges must flow efficiently. Such flow is achieved when the case manager monitors patient progress and intervenes in the event of barriers. Cost and reimbursement are managed by timely discharges, shortened length of stay, timely payer reviews, and concurrent management of denials. It’s a balancing act; however, having some structure to the chaos can help the case manager and social worker to optimize their days.
The emergency department should be considered a patient unit, and the case manager and social worker should triage throughout the day. See the following division of functions for case management and social work in the emergency department as an example.
Social worker functions:
- Abuse/neglect
- Advance directives
- Psychosocial needs
- Emergency department high utilizers and pain contracts
- Domestic violence
- Guardianship questions/concerns
- Homeless issues
- Grief/loss issues
- Coping issues
- Emergency resources (e.g., financial, employment)
- Behavioral health issues
- Community support issues
- No primary care
- Palliative care/end-of-life issues
- No caregiver at discharge
- Substance abuse
- Crisis intervention
Case manager functions:
- Interqual™ criteria/medical necessity documentation
- Education on chronic disease process
- Benefit eligibility/questions
- HINN 11
- Nursing home return
- Home health referral
- 30-day readmission assessment/assessment on observation vs. discharge patients
- Home infusion
- Dialysis
- Home durable medical equipment
- Nursing home placement (new)
- Hospice (new)
- Discharge follow-up phone call
- Patient/family interaction
- Identify emergency department high utilizers and intervene
For more information, see Care Transitions in Case Management. Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.