Can physicians' admission evaluation of patients' status help to identify patients requiring social work interventions?

Overview

OBJECTIVE: To evaluate the utility of these physicians' initial clinical assessments in identifying patients admitted from their homes who subsequently require social work intervention for discharge planning. DESIGN: Retrospective chart review of discharge disposition correlated with a prospective physician evaluation of patients. SETTING: An academic medical center. PARTICIPANTS: Consecutive patients, (2,571) men and women, admitted at the New York Hospital between July 1, 1997 and October 31, 1997. MEASUREMENT: Prospective evaluation of clinical status, functional status, illness severity and stability by physicians within 24 hours of admission. RESULTS: Older patients, sicker and less functional, have higher needs for social work intervention (P < 0.001). New nursing home placement patients were older and had worse function (P < 0.001). Total cost of hospitalization and length of stay were predicted by discharge disposition. CONCLUSION: Early discharge intervention has often been targeted as a potential mechanism to lower hospitalization cost and reduce length of stay. Age and physician evaluation of functional status at admission may provide early identification of those who require social work assistance.