Abstracts

Rationale: In July 2007, the Cleveland Clinic Epilepsy Center hired a full-time social worker to address the psychosocial needs of their patients. One of her duties is to assist with discharge planning of patients determined to have non-epileptic seizures (NES) during video-EEG monitoring. The goal of the current study was to determine if the social worker’s involvement was associated with a reduction in the length of hospital stay (LOS) for these patients. Methods: Adult patients with NES who were seen by the social worker between July and December 2007 were identified (n=32). A second group of patients with NES evaluated with video-EEG monitoring during the corresponding time period in 2006, and who were not seen by a social worker as part of their discharge planning, were also identified (n=18). Patients with comorbid epilepsy and/or syncope were not included. The two groups were then compared on LOS. There were no significant differences between the two groups in age, sex, age at event onset, or duration of time since first event. Results: LOS ranged from 1-9 days during 2006 and from 1-7 days during 2007. In addition, mean LOS was almost one day shorter in 2007 (M=3.63, SD=1.76) compared to the corresponding time period 2006 (M=4.44, SD=2.01). The small sample sizes did not provide enough Power (1-β = .383) to conduct formal statistical analyses comparing group means. However, the effect size, which is not reliant upon sample size, was found to be in the small to medium range (Cohen’s d=.43). Conclusions: These data suggest that involvement of a social worker in discharge planning of patients with NES may have a small to moderate effect in reducing length of hospital stay. Systematic coordination of discharge planning, in conjunction with reduced LOS, also allows patients to receive appropriate outpatient services in a timely manner and is likely to have a substantial financial impact. Future research will further investigate the impact of social work services in the EMU setting and identify potential confounding factors related to changes in institutional practices and policies.