"Psychosocial care leads to fewer readmissions and less work overload for the healthcare system and its staff"

 

Hospital A&E services are the first step in the provision of immediate healthcare. The triage carried out as part of this service involves not just assessing patients' illnesses, diseases and health issues, but also taking into account, among other matters, their social and emotional circumstances. This psychosocial patient care is provided by medical social workers, a key profession that is still largely unknown to the general public due to its lack of widespread implementation in healthcare facilities. 

Anna Albero Miró, a medical social worker with over 20 years' experience who works the night shift at the Hospital Clínic de Barcelona's A&E department and also works as a course instructor and tutor of the Master's Degree in Medical Social Work of the UOC's Faculty of Health Sciences, is a great believer in the inclusion of members of this profession, particularly in hospitals' A&E departments and during evening and night shifts. "There are some very complicated moments when a patient's clinical situation is exacerbated by their helplessness or social problems, and such patients require professional support in order to receive a full care service," said Albero in relation to the need for medical social workers in these initial moments.

 

Hospital A&E services are the first step in the provision of immediate healthcare. The triage carried out as part of this service involves not just assessing patients' illnesses, diseases and health issues, but also taking into account, among other matters, their social and emotional circumstances. This psychosocial patient care is provided by medical social workers, a key profession that is still largely unknown to the general public due to its lack of widespread implementation in healthcare facilities. 

Anna Albero Miró, a medical social worker with over 20 years' experience who works the night shift at the Hospital Clínic de Barcelona's A&E department and also works as a course instructor and tutor of the Master's Degree in Medical Social Work of the UOC's Faculty of Health Sciences, is a great believer in the inclusion of members of this profession, particularly in hospitals' A&E departments and during evening and night shifts. "There are some very complicated moments when a patient's clinical situation is exacerbated by their helplessness or social problems, and such patients require professional support in order to receive a full care service," said Albero in relation to the need for medical social workers in these initial moments.

Medical social work is the psychosocial care provided in the field of healthcare to people whose personal circumstances and health problems can cause them physical dependence or emotional distress. People are not just living beings: we are also psychosocial and spiritual beings. The onset of illness can cause the affected person and those around them to become dependent on others and/or to suffer emotional discomfort. Medical social workers thus seek to establish people's strengths and weaknesses in order to work with them and boost them. People tend to think that vulnerable groups – the elderly, children and people at risk of social exclusion – are the main users of our services, but anyone can need support from a medical social worker at any given time in their life. This could be, for example, someone who has lost a close relative or been diagnosed with a serious illness and is feeling overwhelmed.

We carry out a wide variety of actions in situations ranging from the most insignificant to the most serious. Some cases may seem trivial but are important to the patient. For example, many people are very attached to their pets, and knowing that they have been left alone while they are in A&E or after admission to hospital can be so distressing that it can hinder their care. However, medical social workers in A&E generally deal with all kinds of cases, such as sexual assaults, gender violence, traffic accidents and sudden death. Our job includes locating relatives and supporting staff, for example when they have to give bad news. Providing support in these more serious cases is very important, because many relatives don't know how to deal with the situation, so we try to make sure that they can at least focus on managing their own emotions while we provide emotional support as well as helping with paperwork and any other matters that may arise.

The medical social work we carry out at the A&E department in Hospital Clínic de Barcelona is a 24-hour service, as this healthcare facility has been a charitable institution ever since its foundation. We generally always intervene in any emergency either according to the applicable protocol or at the request of either healthcare practitioners or patients and/or their relatives. In summary, medical social workers take action in each case to assess the patient's needs. The patient's circumstances do not necessarily have to be financial: they can relate, for example, to whether their home is suitable for their current needs or to whether they have family support, among many others. The importance of our work has been highlighted by the pandemic. Although our assistance was often provided over the phone during that time, that phone call was key to the quality of the care and service we provide.

Although no risks may be apparent at first glance, of course there are risks, because all those things that are not dealt with by medical social workers eventually come out and end up harming the patient or their relatives. Although it's also true that the main thing for A&E patients is to receive treatment for their clinical emergency, and everything else is sometimes a bit neglected. However, if these psychosocial aspects are not dealt with, many of these people are likely to come back requiring further healthcare. A good psychosocial intervention thus avoids hospital admissions and costs and helps reduce the distress of relatives and patients as well as of that of the healthcare practitioners who attend to them. Furthermore, patients' relatives are sometimes overwhelmed by the situation themselves and, when we identify that need, we start the necessary social intervention and follow-up process.

The Hospital Clínic de Barcelona is Barcelona's leading hospital for cases of sexual assault in people over 16. This type of care has some of the most complex and complicated procedures, as it involves many professionals, such as gynaecologists, surgeons, nurses, forensic scientists, the police, etc., and they are all coordinated by social workers. Many of these cases happen in connection with nightlife, which means that toxic substances such as alcohol and drugs are also added to the mix and, in order to ensure that adequate care is provided, these interventions may take longer. Unfortunately, the statistics and the number of cases we have to deal with keep rising over the years.

Social work in A&E involves providing tailored professional care in situations whose immediacy means that a social diagnosis to provide a context for the case cannot be carried out. What we do is respond to a need and then provide guidance regarding the dynamics of the service. As people only stay in A&E for a short time, we carry out our intervention and then refer the case for follow-up to the appropriate person, both within the hospital and at other primary care centres. Our interventions are generally based on a crisis model and characterized by immediacy, uncertainty and knowledge of the available resources.

The Hospital Clínic de Barcelona used to be a charity hospital, and patients' access to healthcare was arranged by medical social workers. This could happen at any time of day, which is why the service was available 24 hours a day, 365 days a year. The ability to get involved in every process of the service has consolidated our work as medical social workers in the hospital team. Furthermore, this works both ways. Healthcare practitioners who have seen our work at this hospital ask for medical social workers to be available in other hospitals too. It is ultimately these details in the service that make the difference, improve patient care and allow us to provide a quality service to our users, because anyone can need support from a social worker at any given time.

The main reason why medical social work services are so underdeveloped is financial. However, situations such as the pandemic have highlighted the need to provide this type of care, both face to face and over the phone. Furthermore, it's actually healthcare practitioners and colleagues themselves who are demanding the service, having seen the functions it fulfils.

In the case of A&E, for example, because people don't remain here for very long, patients are not expected to be seen again. In other words, we want to be sure that they are receiving good care and will not require another emergency intervention. Patients being attended to in A&E often feel completely helpless. In order for their care to be comprehensive at these key moments, they must receive support. So the need for medical social work is ultimately obvious, as healthcare staff end up overloaded if it is not provided. Furthermore, many departments have increased the hours of availability of medical social work services. And the additional time will in turn result in an increase in the number of protocols and services involving medical social workers.

Since it was first launched, this programme has laid the foundations of the medical social work in which many people have been working for a long time, thus forming a theoretical foundation. Healthcare is a very complex field requiring specific training such as that provided by the University Master's Degree in Medical Social Work. In addition, as an official master's degree, it gives students access to a healthcare doctorate, something that was previously not possible.

I'm a course instructor and one of the student tutors for the University's Master's Degree in Medical Social Work provided by the UOC's Faculty of Health Sciences.