Emergency medical social work and clinical crisis intervention in a tertiary hospital: A multiple-case study of vulnerable patient populations in Vietnam

Abstract

This study aims to examine how medical social workers resolve acute psychological, legal, and protective impasses among vulnerable emergency patients, and how intrahospital and interagency coordination shapes these outcomes, in a Vietnamese tertiary hospital operating under Circular No. 51/2024/TT-BYT. A qualitative multiple-case study was conducted of five crisis interventions delivered between 2024 and 2026 at a national tertiary referral hospital, purposively selected to span physical abuse, post-discharge exploitation, acute suicidality, guardianship deadlock, and trafficking risk. Case logs, social work records, incident reports, and interagency correspondence were analyzed deductively against Roberts’ seven-stage crisis intervention model and inductively through open and axial coding, informed by trauma-informed care and Bronfenbrenner’s social-ecological model. All five cases reached safe, stabilized outcomes, and in each the definitive medical intervention became possible only after a psychosocial or legal impasse had been resolved. Practice aligned closely with Roberts’ model but required adaptation to engage extended kin and commune authorities, together with boundary-spanning work beyond the hospital. Four recurrent bottlenecks constrained practice: the absence of an expedited mechanism for emergency surrogate consent, the lack of a secure crisis room, reliance on ad hoc charitable funding, and staff exposure to secondary traumatic stress. Manual verification of proxy consent required approximately four to six hours per case. The findings suggest that hospitals should institutionalize a 24-hour interagency rapid-response protocol led by the social work department, digitize civil identity and proxy authorization, establish defined emergency financing pathways, and protect staff through formal supervision and post-incident debriefing.