This study investigated the inpatient to outpatient social work hand off process at a Southern California Kaiser Permanente facility. The purpose of this study was to examine the effectiveness of social work intervention in reducing hospital readmissions.

Secondary data were analyzed from a sample of 73 patients in the hand off group and 73 patients in an equivalent comparison group. Deidentified data were compiled from patients’ charts and other documentation.

Readmission rates were lower in the hand off group (30.1%) than in the comparison group (34.2%), although the difference was not significant. Those in the hand off group who were not readmitted received significantly more social work touches than those who were readmitted. Length of stay, Admissions, Comorbidities, Emergency Visits (LACE) scores (a measure of risk) were also a predictor of readmission in the hand off group but not in the comparison group.

Research continues to be needed regarding the role of medical social workers in reducing hospital readmissions.