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Emergency Department Case Management: The Dyad Team of Nurse Case Manager and Social Worker Improve Discharge Planning and Patient and Staff Satisfaction While Decreasing Inappropriate Admissions and Costs: A Literature Review

Bristow, Darlene P. MSN, RN, CCRN; Herrick, Charlotte A. PhD, RN


A model of emergency department (ED) case management consisting of a social worker and a nurse case manager can prevent inappropriate admissions, improve discharge planning, decrease cost, and enhance patient satisfaction. 3 The individual and combined roles of the dyad team of social worker and nurse case manager are discussed. A literature review includes how a case management dyad team of social worker and nurse case manager in the ED can decrease utilization of the ED for nonemergent visits, promote the use of community resources, and improve discharge planning to avoid excessive costs. The importance of the dyad team working with the interdisciplinary team in the ED, the primary care physician (PCP), and other community health care providers in order to provide a holistic approach to care is addressed. A discussion about the improvement of both patient and staff satisfaction demonstrates the results of case management strategies that support and advocate for patients to receive quality, cost-effective care across the health care continuum, while decreasing the use of the ED for nonemergent care.

Darlene P. Bristow, MSN, RN, CCRN, is the Emergency Department Nurse Case Manager at Wake Forest University Baptist Medical Center in Winston-Salem, NC. This medical center has over 60,000 ED visits yearly and is a level one trauma center. Currently, the ED NCM role consists of monitoring frequent fliers to the ED, assessing appropriate utilization of the ED, instituting guidelines for patient care, and monitoring in-house admissions from the ED for appropriateness and medical necessity.

Charlotte A. Herrick, PhD, RN, is a professor at the University of North Carolina at Greensboro (UNC-G) School of Nursing. She is the Chairman of the Department of Community Practice Nursing. She teaches Nursing Administration Courses at the University. Three years ago, she developed the Nursing Case Management course (N541) for RN to BSN students and graduate students, and a certificate program in Nursing Case Managment for a University of North Carolina at Greensboro certificate in Nursing Case Management. Charlotte may be reached via e-mail:

Address correspondence and reprint requests to: Darlene P. Bristow, MSN, RN, CCRN, Wake Forest University Baptist Medical Center, 300 South Hawthorne Street Winston-Salem, NC 27157 (e-mail:

© 2002 Lippincott Williams & Wilkins, Inc.