University Health Care Services: Walk-in Clinic

Physicians located within wealthier and more populous areas have slightly better access to equipment and infrastructure, but the conditions differ only slightly. Doctors are extremely rushed with a constant overflow of patients and consistently working in hot rooms with little air circulation. This is problem does not only exist in the public clinics of general physicians. Specialist physicians have a persistent flood of patients who do not need a specialist’s care, but seek the specialist because there is no general physician available.

The implications and effects on patients waiting long hours to be seen in the ED are immense. In a recent study done over five years in Ontario hospitals showed the risk of adverse events and even deaths increased with the length of stay in the ED (Science Daily, 2011). When EDs become overcrowded the quality of care changes and declines; which is extremely dangerous. Authors of the study calculated that if ED length of stay was cut by only an hour that 150 fewer Ontarians would die each year (Science Daily, 2011). Wait times can also negatively affect patients financially, untreated medical conditions can lead to reduced productivity and inability to work leading to increased financial strains (Fraser Institute, 2014). As well as delayed access to care can result in more complex interventions needed. Therefore an initiative is needed to provide patients with timely, efficient care when accessing

While the demand of healthcare need increasers the United States facing a physician shortage. In recent years the number of nurse practitioners (NPs) and physician assistants (PAs) has significantly increased and they are taking the part in providing healthcare cervices to the majority of patients. I believe nurse practitioners and physician assistants can practice independently from doctors and be free of oversight. Expanding the scope of NPs and PAs is essential to overcome the healthcare crisis we are facing; it will increase patient satisfaction and stabilizing the healthcare economy.

Hospitals are competing for these patients to justify the continuation of the labor-intensive and expensive program. Both hospitals have the ability to accommodate six patients but hardly reach their full capacity.

When there are Nurse Practitioners that are filling in for doctors, this can improve quality. The way that this takes place is to have these individuals work with select amounts of patients. This creates smaller teams and more personalized attention in providing these services. This is when mistakes will decrease with health care professionals doing more for everyone. Once this happens, is when the underlying quality of care will rise. (“Scope of Practice,” 2010)

Triage is usually the first step of the emergency room and helps determine severity of each patient. Once through triage, the patient

If patients were truly offloaded to NP’s by the triage system it would be cost effective based upon the service rate. But this did not happen. In fact, the percent of patients seen by NPs decreased from 40% to 28%, and the percent patients seen by MDs increased from 41% to 48% (excluding patients that requested a particular provider).

During the second week, I had the opportunity to accompany Mr. Price to meetings that he had with the managers of the nurses and schedulers. During those meetings, the managers discussed the ideal approach of how to accommodate patients who call the schedulers to acquire appointments for urgent medical concerns. There seemed to be a problem with patients taking up appointment slots when they do not have a true need to be assessed by their doctor. It was ultimately concluded that the schedulers would coordinate communication between the patient and the registered nurse. The nurse would then triage the patient’s concerns over the phone and provide medical guidance,

Allocate examination rooms more flexibly and dynamically among individual clinics within each of the programs;

Once you arrive at the emergency room, you experience more waiting depending on your current condition. Some of these waits depend on: length of stay, time waiting for assessment, condition, waiting for inpatient bed, and lack of resources. Finally, when you’re ready to leave the emergency department waits can occur, like waiting for an inpatient bed or a ride home (CIHI, 2012). All of these reasons impact the growing wait times, with older adults becoming more frequent in emergency departments and the increasing population of older adults these wait times are going to continue to grow causing more harm than good, if older adults are unable to receive the appropriate care in a timely matter (Cooke, Oliver, & Burns, 2012).

There are many key components in approaching access to health care: coverage, services, timeliness and workforce (Healthy People 2020, 2015). Patients who have a positive and consistent source of care will ultimately have better end results, minor discrepancies and fewer costs (Healthy People 2020, 2015). Timeliness is the health system’s capability to optimize services in a convenient manner, whether it embraces the time spent either waiting in a doctor’s office or an emergency department. At the same time for many patients it encompasses the time between analyzing the need for tests or treatment and obtaining those results. Working as an ER nurse there has been incredible long waiting times in emergency rooms secondary to the fact that people are using the ER for care and more notably as their primary care physician. Likewise prolonged Emergency department wait times can decrease patient satisfaction and notably people leave without been seen. Finally the different element of workforce is vital in contributing access to health services. Primary Care Physicians (PCPs) play an important role in providing access to health services and it has been noted that many medical students are leaning away from working in primary care (Healthy People 2020, 2015). Our ultimate goal is to direct them towards that needed profession.

Primary care practice will be greatly impacted by health care reform. To provide better health care, the country will see a trend away from specialty to primary care and the avoidance of acute issues by delivering this care in the community setting. As a result, primary care physicians will be overwhelmed with the patient load as the number of the insured increases exponentially. The committee recognizes the scope of nursing practice that remains untapped and therefore the profession

Access to healthcare begins with a patient making an appointment. Disorganized scheduling leads to delays in providing care for patients and frustration among care teams. With patient experience becoming linked to provider payment, an emphasis has returned to reducing patients wait times and increasing patients ease of access to care [1,2]. Recent studies have shown that average wait times at the Veterans Health Administration’s primary care facilities was 42 days [1]. Limited private sector studies have reported similar results with a Massachusetts private sector study revealing average wait times of 39 and 50 days for primary care and internal medicine practices respectively [1].

The challenges of providing reasonable wait times for patients accessing the ED across Canada are exemplified in ERNI in Ontario. One of the challenges of timely, efficient care is the amount of alternative level of care (ALC) patients hospitalized. In one year ALC patients accounted for more than 92,000 hospitalizations. ED wait times are affected by ALC patients by taking beds and resulting

Middletown Hospital is a 200-bed, not-for-profit-general hospital that has an emergency department with 20 emergency beds. The emergency department handles on an average 100 patients per day. The hospital’s CEO has authorized the Six Sigma Team (SST) to address complaints received from patients seeking treatment between 6:00 p.m. and 10:00 p.m. The complaints are centered on waiting times and poor service. During this time the data indicates that approximately 70% of the department’s admissions occur (University of Phoenix, 2009, Course Syllabus).