Hospital Clinic Case

After reading this article, what I recommend that the clinic do to make improvements to

their services there would be to:

1) Not have walk in appointment for their main patients.

2) Create a different strategy for the ambulatory visit.

3) Scheduling changes.

4) Expanding the nurse practitioner guidelines.

My first reason for not doing a walk in clinic for their main patients is because for being a

university and “walk in clinic” it defeats the purpose and the patients who come in who need

help can’t get because the doctors and nurses are already booked with other members. “It seems

that the doctors were allowed “walk in” appointments with their own regular patients. Patients

whose doctors have heavily booked appointment schedules become aware of the doctors walking

schedule and come to the clinic at prearranged times to meet. Our aim isn’t to provide an

atmosphere reminiscent of the country doctor’s office, but rather to provide the best possible care

to all our patients” (page 5 of article). According to the article patients were dissatisfied with

this service. The major complaint was the waiting time between the initial sign in time and the

period where the patient is seen by a doctor. ”A 1978 study of the clinic found that patients who

requested specific doctors at the initial sign in time waited an average time of 23 minutes, more

than 35 minutes for a patient nurse contact and 40 minutes before seeing a desired doctor. When

it came to 1979 the triage system was introduced at the clinic to reduce or to overcome these

problems and the patient who wanted to see a doctor right away increased. After the triage

system was introduced the rate increased up to 24% and it also why the wait time to see a doctor

increased. “If longer treatment by the doctor was anticipated, the patient joined the MD waiting

line, according to his or her AVF #. Thus, any patient in the waiting status quo who had arrived

before the referred patient would still be seen first. The mean times to see a doctor was much

longer (25.2 minutes)” (page 4 of article). According to exhibit 5 (shown in the appendix)

compares pre triage and triage wait times. They both have similar numbers but the pre-triage

wait time was shorter. Going back to recommending the clinic not be walk in would be

beneficial for the clinic but also the patients. I say this because this would help create a better

policy to establish a system where they don’t accept requests from the doctors. With a new

strategy in place, the patients who needs help right away from the doctor can call and make an

appointment to see the specific doctor or use the walk in service for the triage so that the patient

can be accessed.

The next recommendation that I would make for the clinic is to create a different strategy

for the ambulatory visit. I say this because, this form would go along with a new strategy for the

triage system. ‘There are a number of potential alternatives for dealing with this problem. We

could try and educate our patient public on the separate purposes and missions of doctor

appointments and the walk in clinic- try to get them to use each accordingally. They could also

ask the triage coordinators to be a little more aggressive in asking patients who request a specific

doctor” (page 6 of article). By having a new form into place, the triage nurses won’t have to deal

with evaluating and examining how bad the patient’s state is before sending them to a nurse and

the desired medical staff. By doing it this way, it has an advantage for the triage nurses and for

the patient. For the nurses it helps them to figure out if they really need to see a doctor. For the

patient it helps reduce the medical expense that they have to pay if they were to be seen by a

regular doctor. With the AVF forming changing the nurses will be able to help the patients more.

Also, the patients would not feel like they were being bounced from nurse to nurse only to be

asked the same questions over and over again. Fewer patients would be referred to a

doctor for cases that could be handled by a nurse practitioner. Doctors would be free to focus on

patients that do require a higher level of expertise to treat.

Another recommendation for the clinic would be for scheduling. I say this because the

doctors and nurses didn’t schedule anyone based on the quality of the patient demand. When

this happened there were times when the clinic was under staffed. “The walk in clinic was

staffed on the basis of past experience with peak periods of patient visits, which typically

occurred between 10 am and 4 pm. According to exhibit 4 (shown in the appendix) between the

hours of 8 am and 6 pm there weren’t very many doctors or nurses on staff to accompany the

patients when needed.

In addition as to why I think the clinic should change things with their scheduling is

because