INTERVENTIONS

Patrick Pizarro

Practice Experience Week 5

For this week’s Practice Experience post this writer explores key interventions supported by scholarly research evidence to apply to the selected practice problem - in this case, the problem of timely access to care at the Anson Correctional Facility.

Writer, in consultation with the Lead Nurse / Preceptor and Nursing Supervisor at the facility, explored the sick call scheduling process – the time it takes from when a sick call request completed by the offender is received and the time it takes until they are seen for their scheduled medical appointment. Timely access to care depends on how soon an offender with a developing medical problem can be seen and have said problem addressed before it becomes extensive (and expensive).

Looking into the process, the following is noted: typically, the forms are received daily by the medical records department and scanned into the EHR used by the facility (and the whole North Carolina Department of Adult Correction) called HERO. They are then grouped according to housing unit and offenders are scheduled to be seen up to a week after their request is received. Currently, there is no set protocol or time frame governing the receipt to scheduling timeline.  

Additionally, there is no current triage of sick call requests. Although only RNs or higher are allowed to review the requests, they are not sorted by priority. The only nursing judgment used in the process is in determining if the submitted request indicates a medical emergency and in that case the offender is called to main medical to be seen promptly.

Writer suggested a 24-72 hour time frame from receipt to scheduled appointment be tried to ensure timely access to care is received by all offenders at the facility. Grot et. al, (2023) contend in their study that small changes have been shown to have large effects on patient wait times, and enacting a defined time frame, (a small change) would have a clear effect on the current wait time of one week.

Writer also suggested that sick call requests be triaged according to medical priority with higher priority complaints scheduled at the earlier end of the time frame and those of lower priority at the later one. Additionally, writer consulted with the Lead Nurse / Preceptor to suggest that the daily sick call be arranged according to priority instead of alphabetically as is the current practice. This way, the priority complaints are addressed first and not re-scheduled if staff cannot get to them that day. The Committee on Optimizing Scheduling in Health Care stresses that optimizing timely access to care requires measuring the demand, capacity, and flow (2015) which would be attempted by enhancing the scheduling process to take medical priority into account.

 

Grot, M., Kugai, S., Degen, L., Wiemer, I., Werners, B., & Weltermann, B. M. (2023). Small Changes in Patient Arrival and Consultation Times Have Large Effects on Patients' Waiting Times: Simulation Analyses for Primary Care.  International journal of environmental research and public health,  20(3), 1767.  https://doi.org/10.3390/ijerph20031767Links to an external site.Links to an external site.

Committee on Optimizing Scheduling in Health Care; Institute of Medicine; Kaplan G, Lopez MH, McGinnis JM, editors. (2015) Transforming Health Care Scheduling and Access: Getting to Now. Washington (DC): National Academies Press (US); 2015 Aug 24. 2, Issues in Access, Scheduling, and Wait Times. Available from: https://www.ncbi.nlm.nih.gov/books/NBK316141/