what is the evidence for social care intervention in the emergency department? introduction the...
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What is the Evidence for Social Care Intervention in the Emergency Department?
Introduction The current health and social care delivery system is not meeting the needs of an ageing population, the changes in the burden of
disease, and the patient and publics rising expectations [King’s Fund, 2012]. In addition, the UK government’s plans to reform and integrate the delivery of health and social care has yet to be realised [King’s Fund, 2012].
This system failure and lack of integration is adding to the crisis in UK emergency departments (ED), with growing numbers of patients attending, and re-attending for social care needs; as the ED remains a critical point of access for social care [McLeod, E. & Olsson, M., 2006).
A survey of UK EDs suggests an expansion of ED delivered social care interventions [Bywaters et al., 2011] with the aim of improving patient care and system performance. Although the survey demonstrates evidence of innovation and staff perception of benefit there is no systematic review to evaluate the effectiveness of such intentions to guide clinicians, managers and policy makers.
Aims To evaluate the effectiveness of social care interventions in
the emergency department setting; to guide clinicians, managers and policy makers.
Method A systematic review of the literature and evidence synthesis
was undertaken following the PRISMA guidelines where appropriate and applicable.
No restrictions were placed on study design, and both prospective and retrospective data were included; no language restrictions were applied. Studies were included if they described social care interventions located or co-located in emergency departments.
The search strategy (Table 1) was developed in Ovid MEDLINE(R) and searches of other databases were adapted from this template.
The following databases MEDLINE, CINAHL, EMBASE and Web of Knowledge were searched; the reference lists of included studies and previous reviews were also screened.
The titles and abstracts of all retrieved citations were screened by (JE/JDF) for relevance.
The full text was retrieved for all citations considered potentially relevant.
1 exp Social Work/ or exp Social Work Department, Hospital/ or Social work*.mp.
2 social care.mp.3 social welfare.mp. or exp Social Welfare/4 social service*.mp.5 1 or 2 or 3 or 4
6 exp Emergency Medical Services/ or exp Emergency Service, Hospital/ or emergency service*.mp.
7 emergency medical service*.mp.8 "accident and emergency".mp.9 casualty.mp.10 emergicenter.mp.11 emergency department.mp.12 6 or 7 or 8 or 9 or 10 or 1113 5 and 1214 animal/15 animal.mp.16 14 or 1517 human/18 human.mp.19 17 or 1820 16 and 1921 16 not 2022 13 not 21
Results• The search revealed 2,789 of which 99 studies, of variable
quality, were identified as relevant. • The majority of studies were observational including cohort
studies (35) and five were systematic reviews. Only 14 studies reported interventions undertaken in the UK; with the majority of (85/99; 85%) undertaken in the USA.
• Relevant studies were wide ranging; exploring the following health care issues: substance misuse (24), mental health (18), admission avoidance (15), domestic violence (13), child abuse (10), older adult neglect (4), other intentional violence (6), care of the elderly (3) and other studies (6).
• Only 10% of studies use social workers alone; demonstrating that social care in ED is a cross-discipline responsibility.
• A small portion of the relevant studies (8/99; 8%) intervened through staff education only.
• Whilst some studies did demonstrate that social care interventions in the ED can improve patient care and decrease health risk factors, length of stay and recidivism; the quality of the evidence supporting social care interventions in the ED was generally weak. Most studies were small scale, exploring local issues, and not answering the substantive issue of ED re-attendance or reflecting an integrated health social care system.
ConclusionA more robust and focused research programme is required to determine the effectiveness of social care interventions in the ED.
Ms J H Entwisle and Dr J D FisherWarwick Medical School, University of Warwick: [email protected]
Table 1: Medline search strategy
Figure 1: PRISMA Flowchart
References• The Kings Fund. Integrated care for patients and populations: Improving outcomes by working together. London, 2012.• Bywaters et al (2011). ‘ Good intentions, increased inequities: developing social care services in Emergency Departments in the UK’. Health & social care in the
community 19(5):460-7.• McLeod, E. and Olsson, M. (2006) 'Emergency department social work in the UK and Sweden: evaluation by older frequent emergency department attenders',
European Journal of Social Work, 9, (2): 139-157.