Long-stay patients in acute hospitals commonly present with complex psychosocial needs and use high levels of hospital resources. To determine whether a specialist social worker-led model of care was associated with a reduction in length of stay for medically stable patients with complex psychosocial needs who were at risk of a long stay, and to determine the economic value of this model relative to the decision makers' willingness to pay for bed days released.
This is the first study to evaluate a hospital based social work initiative from an economic perspective. We found a specialist social worker-led model of care reduced the average length of stay by 33 days, with 9999 bed days released over 12 months. This translated to a cost of $23 per bed day released. By definition, this study cannot be considered a cost-effectiveness analysis as we did not explicitly account for the value of patients’ health outcomes.
However, length of stay is now a well-recognized measure of resource use and efficiency in hospitals, with delayed discharge resulting in reduced patient flow and ‘access block’ for new admissions. Applying the findings of Page et al that hospital decision makers are willing to pay up to $216 to release 1 bed day, our results indicate there was a 100% chance that adopting the specialist social worker-led model of care described in this study was the right decision, and by extension likely to represent a cost-effective use of resources.
This result is supported by the reality that the study hospital has now formally adopted and funded this model of care on a permanent basis. The new model of care prioritized early identification of patients at risk of long stay, patient tracking, proactive intervention, and system level responses. These four factors promoted a more coordinated and targeted social work response to addressing psychosocial barriers to discharge which in turn assisted in expediting hospital discharge.
Also, early identification of potential long-stay patients was facilitated by clinicians’ greater awareness of the main psychosocial barriers to discharge when conducting initial psychosocial assessments. Although the tendency is for hospital social workers to be referred the most complex patients requiring time-intensive interventions, hospital-based social workers are under increased pressure to demonstrate that the services they deliver are both effective and cost-efficient.
Notably, there has been very limited research conducted on the economic value of social work in hospitals. Auerbach et al. described the ‘cost-containment’ value of social work, which they defined as how effective social workers are ‘in both serving patients and keeping hospital costs down.’ A 2001 study reported on a modeled cost-benefit analysis of social work services in the ED setting and found that dedicated social work staffing of EDs may yield net economic benefits to a hospital system, especially in large urban centers.
However, a literature review did not identify any economic evaluations of hospital-based social work initiatives. This may be a reflection of the interpersonal nature of the profession in which outcomes have traditionally been measured subjectively or qualitatively. However, as hospital decision making becomes increasingly focused on the provision of high-value care, it is important for the social work discipline to demonstrate the economic, as well as the clinical, value of their work.