Retooling social work practice for high volume, short stay.

The re-engineered acute care environment that emphasizes managed care, reduced costs per case and shorter lengths of stay also demands innovative approaches to the delivery of social work service. As departments disappear and other professions compete for roles in counselling, discharge planning and community liaison, there is a real threat to the viability of the acute hospital as a setting for social work. This paper focuses on the adaptive skills needed for the restructured acute care context, including (1) the creation of key roles for social work on the multidisciplinary team, (2) pre-admission high-risk screening and discharge planning, (3) high volume recording, (4) solution-focused brief interventions, and (5) the development of community partnerships. These conceptual strategies are implemented differently in examples drawn from three distinct high-volume patient groups: reconstructive orthopaedics, high-risk fetal assessment and thoracic oncology.