Update from UW Medicine – Lopez Island Hospital District

August 8, 2017

Lopez Island Public Hospital District #2
Lopez Island, Washington

At the request of the Lopez Public Hospital District (PHD), the following is an update from UW Medicine related to the opening of a UW Medicine Primary Care and Urgent Care Clinic on September 25, 2017.

General Summary:

The preparation and planning efforts over the past 2 ½ months has provided the opportunity to build a strong foundation to support the successful opening of a UW Medicine Primary/Urgent Care Clinic. At this time the transition efforts noted are in “Green” status. The work and preparation spans from IT / Network infrastructure planning and improvements, telecom transition, staffing model adoption, provider and mid-level recruitment, training and socialization of UW Medicine resources and tools and most important, opportunities to interface and partner with community members and services important to a successful primary care model. In addition, the support of emergency medical services in collaboration with Lopez Fire and EMS will continue as it is today, which is a cohesive partnership related to the delivery of primary and emergency services. Lastly, the expansion of programs, services and operations will occur over time as new systems are adopted and new providers are brought on board. As services and operations expand, updates will be provided to the Lopez PHD for visibility and support.
The following information is presented to assist the Public Hospital District and respected commissioners with public messaging and visibility to UW Medicine’s position and commitments to the opening and delivery of a quality primary care clinic that consistently focuses on the patient experience.

The clinic will provide the following services:

Family medicine
Adult and child immunizations
Chronic disease management
Family planning
Physical exams
Preventive healthcare
Radiology and laboratory services
Routine diabetes care
Women’s health
Integrated behavioral health
Acute illness and injury
Patient education
Musculoskeletal care
Pregnancy testing
Sports and employment physicals
Spirometry
Telemedicine (Specialty/Behavioral Health)
Virtual Clinic

Additional resources available:

Advanced laboratory point of care testing
Digital X-ray services

Lopez Fire and Emergency Medical Services (EMS) Partnership:

UW Medicine continues to be committed to developing and sustaining a collaborative relationship with Lopez Fire & EMS built on our philosophy of ensuring that patient care is the top priority.

Patients with acute/urgent care needs transported to clinic during normal business hours by Lopez EMS will be accepted, evaluated and treated within the scope of Primary and Urgent Care services
Lopez EMS was notified the urgent care area of the clinic can be used by EMS after hours. A license agreement was provided on 6/21/2017 – a response to the agreement has not been received as of 8/8/17.
Lopez EMS was notified that walk-in urgent care patients (often with EMS Assist) will be supported and managed as urgent care patients, triaged by a Registered Nurse and with the support of a Physician or ARNP determined to be appropriate for Urgent Care services or determined if the patient requires continued EMS support and management.
UW Medicine has committed to participating in monthly EMS ‘run reviews’ to evaluate how the clinic can support patient care, follow-up and management of patients’ chronic care issues – with a goal to minimize the patient’s future calls and support patients with their urgent needs (acute/chronic).
Dr. Robert Wilson has been approved to continue serving in the role of Medical Control for Lopez Fire & EMS. Please note: A contract between UW Medicine and Lopez EMS will need to be finalized prior to 9/25. This agreement allows for Dr. Wilson to be consulted on EMS calls 24/7. Per Dr. Wilson, “this does not mean he is providing after hours care – primarily he is providing guidance whether to transport the patient off island or instructing EMS to have the patient follow up in the clinic the next day.” In 2016 per EMS data, Dr. Wilson was contacted and provided after-hours care 25 times.

UW Medicine leadership team (Jay Priebe, Debra Gussin, Dr. Mike Alperin – Rural Clinic Chief) are committed to a continued focus on evaluating what services need to be provided and supported in the clinic. This includes assessing and evolving the support model between the Lopez EMS and the Primary Care Clinic as related to scope of and best clinical practices. This requires continued assessment of patient related urgent/emergency type scenarios. Once the clinic opens and adoption of a new EHR has occurred, the assessment of such urgent/emergency situations can be conducted on a regular basis. As such, guidelines, procedures and support resources will be developed to ensure the clinic staff and providers can successfully support Island emergency care situations alongside Lopez Fire & EMS.

While the clinic is a primary/urgent care service, we must be cognizant of when Emergency Medical Services must be utilized and called on to manage the emergency needs of patients. The clinic can serve primary and urgent care needs as noted above (services provided), but must leverage the Lopez EMS for all emergency medical issues such as patient complaints of airway, breathing and circulation. The EMS team is better suited to manage and support these types of emergency issues.

Emergency Medical Equipment:

The UW Medicine team is actively assessing what emergency medical equipment needs to remain in the clinic and what equipment is ‘duplicative’ given the Lopez Fire & EMS team has the same emergency care equipment and medications. In the event the patient situation becomes an emergency and medications maintained by EMS are required the clinic staff/providers will call 911 for EMS support. For example, intubation equipment and medications required for patients who are unable to breathe on their own is best managed by the Lopez Fire and EMS. The providers and staff can provide emergency airway and rescue breathing while awaiting EMS response and determination to intubate and place a patient on a ventilator.

All clinical staff (providers and registered nurses) are trained in Acute Cardiac Life Support (ACLS) and as such equipment and medications to support cardiac arrest must remain in the clinic to provide immediate and prompt care to patients. This equipment is standard in all primary care clinics and is used to initiate emergency care while awaiting EMS services.

With continued assessment of what equipment is required in the clinic, a determination must also be made regarding what additional training and support providers and staff need to efficiently use such equipment. The leadership team, clinic providers and staff will work collaboratively over the next 6 months to evaluate what additional training and resources they need to provide urgent care services in the clinic.

Operations:

Hours of operation are expected to expand shortly after the opening to include:

Clinic opening at 7:45am (first patient seen at 8am) and closing at 6pm (last patient seen at 5:45pm).
New hours of operation allow for an increase of 35-40 patient appointments a week
Clinic will no longer be closed during lunch hours
A Virtual Clinic will be available for patients who want to be seen quickly in the clinic – Does NOT require a scheduled appointment and can support most patients’ acute issues such as common cold, earache, headache, etc.

Provider Recruitment / Staffing:

The UW Medicine team is making steady progress in the recruitment, contracting and credentialing of providers for the clinic.

Dr. Robert Wilson has signed a contract and is progressing through the credentialing process. This includes working to finalize the legal agreements with the Lopez Fire District allowing Dr. Wilson to remain Medical Control for Emergency Medical Services on Lopez Island.
Once credentialing of Dr. Wilson has been complete, the Medical Control agreement can be presented to Lopez EMS for negotiation and finalizing.
Advanced Nurse Practitioners (ARNP) are interviewing and are scheduled to visit the clinic and meet with Dr. Wilson and the clinic manager over the next month.
An interim physician (Dr. Angad Singh) is scheduled to support the clinic opening starting 9/25 thru Mid-October. This will allow the leadership team additional time to finalize the hiring and contracting of an ARNP for the clinic. Dr. Singh is a respected and valued physician with UW Neighborhood Clinics and is a subject matter expert with UW Medicine’s EPIC EHR System. Dr. Singh will be a great support for Dr. Wilson and staff during the Epic electronic health record adoption phase.
Dr. Pam Sheffield, Associate Medical Director for UW Neighborhood Clinics will also provide support to the clinic as needed to ensure patients are able to be seen and that access to care is not limited at the time of opening the clinic.

Clinic Staffing:

99% of the clinic staff who interviewed have been offered a position at the clinic with a start date of 9/23/17.
The clinic is currently recruiting for an X-Ray/Phlebotomist position, which will likely be filled no later than 10/1/17. This dedicated full-time position will provide a significant service to the Physician and ARNP providing X-Ray and Lab services to patients. Lab appointments will be available Monday – Friday from 8-12pm.
All staff positions are now 32, 36 & 40 hour a week positions geared to support continuity and quality of care goals and initiatives. This staffing model approach also provides physicians and ARNP’s a strong model for efficient and timely delivery of care.

On behalf of Debra Gussin, Executive Director for UW Neighborhood Clinics and myself, I would like to thank the Lopez Public Hospital District and Lopez community for choosing UW Medicine as their healthcare provider. Please don’t hesitate to inquire if additional questions come forward related to the content noted within the update.

Respectfully,

Jay Priebe, M.B.A., CSSGB
Director of Rural Primary Care Operations
UW Medicine Box 354943 | Seattle, WA 98195 Phone: 206.520.2290 | Fax: 206-520-2298 |
Toll free: 1.855.520.2290 | Toll free fax: 1.855.520.2298
jpriebe@uwpn.org

Debra Gussin MSW MPA
Executive Director UW Neighborhood Clinics
UW Medicine Contact Center
Box 354943 | Seattle, WA 98195 phone:206.520.4862 | fax:206-520-0402 |
dgussin@uwpn.org