Addressing Psychosocial Barriers to Hospital Discharge: A Social Work Led Model of Care

Australian hospitals regularly care for patients who cannot be discharged routinely due to complex psychosocial needs that manifest as barriers to discharge. These long-stay or stranded patients are at risk of detrimental health outcomes resulting from their extended stay while also potentially delaying admission for those who need acute care. This article discusses a new social work led model of care developed at an Australian metropolitan hospital that targets long-stay patients with psychosocial barriers to discharge. The model of care, overseen by a specialist social worker and assistant, demonstrates how the social work profession can take leadership within the psychosocial realm to improve both organisational and patient outcomes. IMPLICATIONS. Facilitating the timely discharge of hospital patients who no longer require acute care is crucial to optimising their health outcomes.. Hospital social workers can take leadership of the management of long-stay patients where psychosocial barriers to discharge are present.