The social worker as primary psychiatric consultant to the general hospital emergency room.

Providing coverage for the increasing number of psychiatric and social crises presenting in general hospital emergency rooms presents a challenge during this era of economic contraction. A model is presented for the development of a crisis team without additional funding, utilizing half-day shifts contributed by clinical social workers who hold full-time positions elsewhere in the hospital. Effective and efficient emergency clinical work required that the social workers be taught about biomedical issues pertinent to presentations, along with instruction as to why and when to seek consultation from backup psychiatrists. Quality of care and continued skill development are addressed through the use of a systematic data base and interdisciplinary case conferences using the psychiatrist as a consultant regarding psychopharmacological and diagnostic issues.