Case: University Health Services: Walk-In Clinic Essay

668 Words Oct 1st, 2013 3 Pages
Case: University Health Services: Walk-In Clinic
Kathryn Angel has been hired as assistant director for ambulatory care at Harvard’s University Health Services. By implementing a triage system, she wanted to reorganize the Walk-In Clinic.
The staff of the clinic includes 22 physicians, 2 registered nurses and 11 nurse practitioners.
Physicians : 40 hours per week, in blocks of three to four hours; in total 150 hours per week available to the Walk-In Clinic
12 hours in Walk-In Clinic
16 hours meeting patients by appointment (including 2 half-hour periods ‘reserve time’)
5 on duty at the UHS infirmary
7 on administrative and other matters
Registered nurse: eight-hour shifts, including one hour for lunch, can treat minor ailments
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As Kathryn Angel, how do you evaluate the introduction of the triage nurses into the process of the Walk-in Clinic ?
The average total waiting time was more than expected (37.5 minutes, including triage time). There were two main problems:
The triage coordinators are sometimes classifying patients as physician/nurse practitioner to maintain the flow when they feel the practitioners are backed up. So the physician’s share of patients gets increased in overload situations. The mean waiting time to see a physician was much longer (25.2 minutes) than the mean waiting time to see a nurse practitioner (6.7 minutes).
24% of all patients ask to see a specific doctor or nurse. The waiting time for triage is always the same, but patients who asked for a specific provider had to wait an average of 8.6 minutes longer.
Two of the five doctors on duty are 100% occupied with ‘walk-in appointments’. So the available MD resources decrease by 40% and fills up the waiting room. People want a practitioner who knows them well, but the aim of the UHS Walk-In Clinic is to provide the best possible care to all their patients, particularly those whose medical needs are almost urgent.
How can the waiting times be improved and the complaints be reduced ?
First of all, they need to expand the 13 nurse practitioner guidelines and they also have to define further the roles of
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