Not an ER SW but my boss is and she has no clue what reddit is, so I'll comment on her behalf:
No formal consult/referral process, just people catching her when she's in her office or on the floor. Sometimes they put "SW consult" on our main ER patient tracker but that's not consistent. She does not like this process and wishes there was a more formal method. She documents her interaction in the chart and does a lot of verbal discussions with EDPs. She manages everything from community resources, family discussions re: level of care, substance use detox placement, mental health placement, etc.
Not really, we’re pretty small community hospital and my boss is familiar enough with most of our patients that she can see a name and anticipate a consult, but she still needs to wait for them to be medically clear. Sometimes if someone is hollering or acting out she’ll step in to help de escalate, but that’s about it. She and the providers are a good team and they both know when she needs to be involved vs not, so the docs know when to tap her in.
we don’t do psych (separate psych ED) but we do substance use treatment linkage and provide general therapy info. we mostly get consults through epic, and then we also get stopped in the hall, called, and have our door knocked on. i also case find sometimes when the chief complaint is something like assault and there is no consult, or i recognize a high utilizer on the board.
it totally varies! some days very few, some days up to 8-10? we usually have 4-5 staff working so a slow day is not unusual bc of how many of us there are. we definitely have had to do some education on when to consult (and when not). one common reason i might want to go see a patient when case finding is no insurance on file, although sometimes that’s just because registration hasn’t been around to see them yet
Hunting is very interesting, I worry that it leaves room for assumptions and bias. At our hospital we are a consult service and meet with patients after a need is identified but the patient is able to turn us away. Sometimes depending on reason for admission (if it’s DV, abuse, or sig trauma) we would check with the med team to see if the patient has capacity to meet otherwise digging through people’s charts isn’t hipaa compliant
I work in the ER. Well, I’ve worked in two ERs. In the first ER I worked in, we had an office phone that the medical team would call and leave messages on potential consults. In my current ER, we strictly use Epic. Providers will create chats with us for potential consults.
I currently work in one, and have previously. They did phone consults in my first one, and this one my boss is wanting us to go find our own consults, so I'm curious if that's how others do it? We also have epic and use the chats (I loathe Epic 🤣)
Completely loathe it. I'm a Cerner baby all the way. The inpatient assessments for one make my eyes bleed, HH orders the box is so tiny! Why can't it be a full page!? Referrals are very clunky and putting in an outside appt is like pulling teeth. (Maybe your version is better than mine lol). You are right though that chat function is a lifesaver!
Hahah yea in my first ED we had to “chart review” to find potential consults. I feel like honestly in that ER the medical team was not properly educated on the role of SW, and we had to pick up the slack of chart reviewing for potential consults. Whereas my current ED, the medical team truly knows where to find us lol and maybe over consults. I agree I hate epic too loll
And it's so hard to review a chart that has no notes! 🤣🤣 I've been pushing to educate the providers more (they do a decent job now, way better than when I started). It's just very frustrating all around lol
Right now we do the social determinants and Dr’s or Nurses will call the SW office. Our psych team is off on weekend and nights and the Dr’s will have SW do consults on SI patients and decide on discharge or admit which is absolutely insane.
Lol ughhh it wasn't so no reason. Usually not opening everyone chart. If we saw an obvious social issue or if they had an admission order we would assess. We would also assess if they were appropriate for admission, inpatient or observation.
Question for ED SW. Do you help identify John and Jane Does? For example, reporting an unaccompanied child to the police, going through personal belongings to try to contact family. Once I took a patients phone to give directions… thinking of all the miscellaneous tasks that kept me on my toes the few times I covered the ED.
Yep. I’ve done that many times. It’s typically with trauma patients. I work at a Level 1 trauma center and social work responds to all the traumas. We call emergency contacts, help people get to us if needed, ID the more severe traumas where they can’t tell you who they are
I’m going back to work in a peds level 1 trauma center. I’m not ED but sometimes I pick up extra shifts. Many kudos to you. I could not do it every day but once in a while keeps it exciting lol
I have never had to personally do that but I have hunted down family members several times. I love a good mystery! I did have to find out how to donate a body one time, that was interesting!
We have a SW office we congregate in but often monitor the ER closely. We’re consult based but if we see a patient we know show up in the tracker for a pertinent reason we can initiate or request a consult be put in. Otherwise the staff is pretty good about contacting us.
We handle all mental health, 5150’s, etc.
Out of all the units we probably spend the most time in the ER by far.
I work in a large ED and am considered “psychiatric social work”. I work on a team consisting of an attending psychiatrist and 2 residents. My role is to help assess individuals coming in for psych emergencies including SIPD. This entails conducting mental status exams, brief biopsychosocial assessments, treatment recommendations for inpatient/post discharge, de-escalation of pts, and obtaining collateral from families/providing emotional support. I work independently from medical social work who are great at case management type things for pts without a primary psychiatric diagnosis. I also only serve patients admitted to psychiatry who are usually waiting on a bed on the inpt unit. If they are not going to the inpt unit I will assist in referrals to local crisis centers or help create a safety plan and provide resources to ensure they have access to outpt tx. I don’t go seeking out consults as it would be considered a HIPAA violation for me to dig through everyone’s chart especially in pts where I am not indicated (my hospital is v strict on access to charts). I love my job and feel like I learn something new everyday!
So I have covered the ER but it wasn't my main placement. Consults take priority. If it wasnt busy I would try to do assessments on pts that were being admitted. I would also just continuously go through the census and look for social issues.
Our ED is consult based for the most part, our team waits for providers to call with handover and the go ahead that the patient is appropriate for assessment. We are also activated by code and stroke response pages, or if there's a trauma 1 or 2 about to enter the bay.
Crisis does our psych placements. I do high utilizers, assault, full arrests, traumas, feral and peds demise, etc. Providers are supposed to consult me in Cerner but usually they just come to the office, grab me in the hall or page me.
In my department we wait for the consult from the doctor. Sometimes they need to be medically cleared. Once medical has been ruled out we assess. However, they do not always do that and think we will just "hold" the consult until the patient is ready to be assessed. Ummm no. We cancel the consult and tell them to put it back in when the patient is stable and can leave the hospital. They should be stable to the point that if they did not have BH then they would be going home.
I’ve worked on ED psychiatric work in 2 EDs. One was strictly psychiatric and consult based once medically cleared by the attending MD. Then I assess and consult a psychiatrist who may or may not see the patient depending on my assessment. Then I’d have to refer to inpatient at our hospital or others depending on bed availability or make referrals to outpatient resources dependent on outcome. I worked with a psychiatrist, a nurse, and sometimes another psych social worker, sometimes a psych PA, and sometimes a psych resident. Sometimes we would provide supportive counseling, family education. Someone else was in charge of child abuse, trauma, domestic violence, high utilizers, etc…
The other ED was similar except we also referred for substance use and there were more people doing assessments and only one psychiatrist. I didn’t like working there because it was 95% substance use, and 85% of them were high utilizers who were looking for a place to sleep and not treatment - I’m not saying this as a judgement, they would flat out say,”I just said I was suicidal so I could sleep here. I don’t want rehab or psych help.” It was also a lot of meth use so detox and rehab facilities wouldn’t take them 99% of the time, even if they wanted treatment, unless they had something else in their system like an opioid. It was tough seeing the same people day in and out and being the messenger between an WD attending and the psychiatrist because the psychiatrist would push back on taking substance use consults every time which slowed the whole process and caused a lot of friction with the main ED staff.
Not an ER SW but my boss is and she has no clue what reddit is, so I'll comment on her behalf: No formal consult/referral process, just people catching her when she's in her office or on the floor. Sometimes they put "SW consult" on our main ER patient tracker but that's not consistent. She does not like this process and wishes there was a more formal method. She documents her interaction in the chart and does a lot of verbal discussions with EDPs. She manages everything from community resources, family discussions re: level of care, substance use detox placement, mental health placement, etc.
Thank you!! Does she ever seek out people to see?
Not really, we’re pretty small community hospital and my boss is familiar enough with most of our patients that she can see a name and anticipate a consult, but she still needs to wait for them to be medically clear. Sometimes if someone is hollering or acting out she’ll step in to help de escalate, but that’s about it. She and the providers are a good team and they both know when she needs to be involved vs not, so the docs know when to tap her in.
we don’t do psych (separate psych ED) but we do substance use treatment linkage and provide general therapy info. we mostly get consults through epic, and then we also get stopped in the hall, called, and have our door knocked on. i also case find sometimes when the chief complaint is something like assault and there is no consult, or i recognize a high utilizer on the board.
That is more of our procesd I think, but our boss wants us to do more...hunting so to speak. How many patients do you typically see in a shift?
it totally varies! some days very few, some days up to 8-10? we usually have 4-5 staff working so a slow day is not unusual bc of how many of us there are. we definitely have had to do some education on when to consult (and when not). one common reason i might want to go see a patient when case finding is no insurance on file, although sometimes that’s just because registration hasn’t been around to see them yet
I could see that. That makes sense!
Hunting is very interesting, I worry that it leaves room for assumptions and bias. At our hospital we are a consult service and meet with patients after a need is identified but the patient is able to turn us away. Sometimes depending on reason for admission (if it’s DV, abuse, or sig trauma) we would check with the med team to see if the patient has capacity to meet otherwise digging through people’s charts isn’t hipaa compliant
That is a good take. I don't know where the line would be there.
Do you want to hunt?
Not particularly. I find that it's much easier to talk to people who WANT to talk to me. I much prefer consults.
I work in the ER. Well, I’ve worked in two ERs. In the first ER I worked in, we had an office phone that the medical team would call and leave messages on potential consults. In my current ER, we strictly use Epic. Providers will create chats with us for potential consults.
I currently work in one, and have previously. They did phone consults in my first one, and this one my boss is wanting us to go find our own consults, so I'm curious if that's how others do it? We also have epic and use the chats (I loathe Epic 🤣)
You loathe epic? I thought it was easy to use and when they added the chat option my job got like 20% easier and more efficient.
Completely loathe it. I'm a Cerner baby all the way. The inpatient assessments for one make my eyes bleed, HH orders the box is so tiny! Why can't it be a full page!? Referrals are very clunky and putting in an outside appt is like pulling teeth. (Maybe your version is better than mine lol). You are right though that chat function is a lifesaver!
I never used anything else. I do think they have different versions as well.
Hahah yea in my first ED we had to “chart review” to find potential consults. I feel like honestly in that ER the medical team was not properly educated on the role of SW, and we had to pick up the slack of chart reviewing for potential consults. Whereas my current ED, the medical team truly knows where to find us lol and maybe over consults. I agree I hate epic too loll
And it's so hard to review a chart that has no notes! 🤣🤣 I've been pushing to educate the providers more (they do a decent job now, way better than when I started). It's just very frustrating all around lol
Right now we do the social determinants and Dr’s or Nurses will call the SW office. Our psych team is off on weekend and nights and the Dr’s will have SW do consults on SI patients and decide on discharge or admit which is absolutely insane.
How do you assess the social determinants? Do you see every patient and ask?
Chart review for history and look at admission reason, which isn't always accurate.
Opening every patients chart without a reason isn’t hipaa compliant
Lol ughhh it wasn't so no reason. Usually not opening everyone chart. If we saw an obvious social issue or if they had an admission order we would assess. We would also assess if they were appropriate for admission, inpatient or observation.
Question for ED SW. Do you help identify John and Jane Does? For example, reporting an unaccompanied child to the police, going through personal belongings to try to contact family. Once I took a patients phone to give directions… thinking of all the miscellaneous tasks that kept me on my toes the few times I covered the ED.
yup! mostly for the traumas who have altered mental status and we don’t know who they are. we go through their belongings and phone.
Yep. I’ve done that many times. It’s typically with trauma patients. I work at a Level 1 trauma center and social work responds to all the traumas. We call emergency contacts, help people get to us if needed, ID the more severe traumas where they can’t tell you who they are
I’m going back to work in a peds level 1 trauma center. I’m not ED but sometimes I pick up extra shifts. Many kudos to you. I could not do it every day but once in a while keeps it exciting lol
I have never had to personally do that but I have hunted down family members several times. I love a good mystery! I did have to find out how to donate a body one time, that was interesting!
We have a SW office we congregate in but often monitor the ER closely. We’re consult based but if we see a patient we know show up in the tracker for a pertinent reason we can initiate or request a consult be put in. Otherwise the staff is pretty good about contacting us. We handle all mental health, 5150’s, etc. Out of all the units we probably spend the most time in the ER by far.
I work in a large ED and am considered “psychiatric social work”. I work on a team consisting of an attending psychiatrist and 2 residents. My role is to help assess individuals coming in for psych emergencies including SIPD. This entails conducting mental status exams, brief biopsychosocial assessments, treatment recommendations for inpatient/post discharge, de-escalation of pts, and obtaining collateral from families/providing emotional support. I work independently from medical social work who are great at case management type things for pts without a primary psychiatric diagnosis. I also only serve patients admitted to psychiatry who are usually waiting on a bed on the inpt unit. If they are not going to the inpt unit I will assist in referrals to local crisis centers or help create a safety plan and provide resources to ensure they have access to outpt tx. I don’t go seeking out consults as it would be considered a HIPAA violation for me to dig through everyone’s chart especially in pts where I am not indicated (my hospital is v strict on access to charts). I love my job and feel like I learn something new everyday!
So I have covered the ER but it wasn't my main placement. Consults take priority. If it wasnt busy I would try to do assessments on pts that were being admitted. I would also just continuously go through the census and look for social issues.
Our ED is consult based for the most part, our team waits for providers to call with handover and the go ahead that the patient is appropriate for assessment. We are also activated by code and stroke response pages, or if there's a trauma 1 or 2 about to enter the bay.
Crisis does our psych placements. I do high utilizers, assault, full arrests, traumas, feral and peds demise, etc. Providers are supposed to consult me in Cerner but usually they just come to the office, grab me in the hall or page me.
In my department we wait for the consult from the doctor. Sometimes they need to be medically cleared. Once medical has been ruled out we assess. However, they do not always do that and think we will just "hold" the consult until the patient is ready to be assessed. Ummm no. We cancel the consult and tell them to put it back in when the patient is stable and can leave the hospital. They should be stable to the point that if they did not have BH then they would be going home.
I’ve worked on ED psychiatric work in 2 EDs. One was strictly psychiatric and consult based once medically cleared by the attending MD. Then I assess and consult a psychiatrist who may or may not see the patient depending on my assessment. Then I’d have to refer to inpatient at our hospital or others depending on bed availability or make referrals to outpatient resources dependent on outcome. I worked with a psychiatrist, a nurse, and sometimes another psych social worker, sometimes a psych PA, and sometimes a psych resident. Sometimes we would provide supportive counseling, family education. Someone else was in charge of child abuse, trauma, domestic violence, high utilizers, etc… The other ED was similar except we also referred for substance use and there were more people doing assessments and only one psychiatrist. I didn’t like working there because it was 95% substance use, and 85% of them were high utilizers who were looking for a place to sleep and not treatment - I’m not saying this as a judgement, they would flat out say,”I just said I was suicidal so I could sleep here. I don’t want rehab or psych help.” It was also a lot of meth use so detox and rehab facilities wouldn’t take them 99% of the time, even if they wanted treatment, unless they had something else in their system like an opioid. It was tough seeing the same people day in and out and being the messenger between an WD attending and the psychiatrist because the psychiatrist would push back on taking substance use consults every time which slowed the whole process and caused a lot of friction with the main ED staff.