Social-work service in the emergency department to improve care for the vulnerable older patient: a local experience in Italy

Unlabelled: . Social-work service in the emergency department to improve care for the vulnerable older patient: a local experience in Italy. Introduction: The needs of older and frail people are increasing, and specific pathways in healthcare settings are needed. Aim: To describe the services and discharge destinations of people >65 years old with vulnerabilities followed by a new social care service in the emergency department (ED). Methods: All patients referred to the social care service in the ED of a hospital over an eleven-month period were included. The service consisted of a social worker available from 9 am to 3 pm in the ED to assess the post-discharge health and social care needs of users identified by the ED doctor. Interventions carried out, post-discharge destinations and services activated were assessed. Results: Between January and November 2022, 145 patients (median age 84 years) accessing the ED were referred to the social care service. The reasons for accessing the ED were medical conditions (93, 64.1%) and injury-related issues (52, 35.9%), particularly falls. The services provided included initiating procedures for long-term care placement (56.1%), consultations, referrals to municipal social services, activation of procedures for legal guardianship, and notification to the general practitioner. Overall, 46.6% of patients were admitted to a long-term care facility, 37.9% were discharged home, and 10.9% to a temporary post-acute care facility. Patients accessing the ED for injury-related issues and admitted to the hospital were more frequently institutionalized. Conclusions: Ninety-two patients (63%) referred to social workers did not require hospital admission. Social workers provided valuable services to vulnerable elderly patients in the ED to ensure the most appropriate support after discharge.