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| ==Overview==
| | '''Welcome to the Outpatient Primary Care Resource Page.''' Please follow the links below to find information about caring for patients in our outpatient clinics. |
| The Yukon Kuskokwim Outpatient Clinics provide care for approximately 27,000 Alaska Native Patients, which includes Bethel as well as 48 surrounding villages. The outpatient clinics provide about 45,000 visits a year. Family Medicine, Women’s Health, Obstetrics & Gynecology, Pediatric physicians and advanced professional providers, staff the clinics.
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| Approximately 50% of the clinic volume is made up of village patients who have arrive in Bethel by plane, boat, snow machine, river taxi, or hovercraft.
| | ==GENERAL OUTPATIENT CLINIC INFORMATION== |
| | *[[Outpatient Clinic Introduction]] |
| | *[[Outpatient: Detailed Information|Pediatric Outpatient Introduction]] |
| | *[[Clinic Workflow]] |
| | *[[:Category:RAVEN|Electronic Health Record (EHR)]] |
| | *[[Outpatient Nursing]] |
| | *[[Bethel Regional High School Clinic]] |
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| Village patients often arrive early or late for scheduled appointments due to plane schedules, weather and other mitigating factors. Many of our village patients are often seen in the village due to the increased cost of travel, weather, work or personal responsibilities at home. Health Aides will initiate care but often times the clinical issue could not be resolved at the local level. When these patients arrive in Bethel, providers attempt to resolve all of their health maintenance issues at that visit so the patient is not traveling back and forth from the village.
| | ==COMMON OUTPATIENT ENCOUNTERS== |
| | | *[[Clinic Appointments/Encounters|Common Outpatient Encounters]] |
| Bethel patients make up about 50% of the remaining appointments, which include some of the nearby villages. These patients are seen more frequently on average given their proximity to Bethel.
| | *[[Specific Types of Appointments and Procedural Processes|Outpatient Pediatric Encounters]] |
| | | *[[Common Outpatient Procedures]] |
| Our clinic patients are complex with a higher acuity than patients normally seen in lower 48 outpatient clinic settings. Many of these issues are related to household overcrowding, lack of running water, exposure to environmental tobacco smoke and indoor air pollution. All of these factors contribute to increased risk of serious bacterial and viral infections in this population.
| | *[[Immunizations/Well Child]] |
| | | *[[Outpatient Clinic Introduction#Medication Refills|Medication Refills]] |
| Some of the organisms that you will encounter in the clinics are streptococcus ''pneumoniae,'' which is the leading cause of pneumonia and neonatal sepsis in the region. ''Haemophilus'' influenza type A and B causing meningitis, urinary tract infections, osteomyelitis. Cellulitis, abscess and sepsis infections caused by ''streptoccous staphyloccous'', specifically MRSA. Our most significant and complex medical entity in the region is mycobacterium tuberculosis. Which should always be included in the differential of many of our patients.
| | *[[Regular (Outpatient) RMT|Outpatient RMT Common Scenarios]] |
| | | *[[Outpatient RMT Workflow]] |
| Health Aides are the backbone of our unique medical system here in the Yukon Delta. They provide much of the basic care in our villages. Many of the patients seen in clinic have been evaluated by a Health Aide under the guidance of a medical provider through radio medical traffic. These patients are sent to Bethel because they require a high level of medical care. This care may involve complex lab work, radiological images or referral services.
| | *[[:Category:YKHC Guidelines#Outpatient Guidelines|Outpatient YKHC Clinical Guidelines]] |
| | | *[[INTRA and INTERhospital Transfers|Admissions and Transfers]] |
| Some of the more serious patients are sent directly to the emergency room with clinic follow up the following day. These patients may not warrant hospitalization at the time, but require close outpatient follow up. These patients are provided a place to stay at the hostel on the hospital campus with daily follow up until the patient is medically stable to return to the village.
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| The Outpatient Clinic functions more like an urgent care at times given that medical providers are coordinating placement of heplock, IV fluids, urine catheterization, IV antibiotics, incision and drainage of abscesses as well as joint injections and cast placement.
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| Clinic providers not only provide complex primary care, but also function as specialists given that many of our subspecialists are either in Anchorage or a state away. Providers consult via telemedicine, phone or email in order to develop as well implement plan of care for their patients.
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| Pediatric patients make up a significant portion of the population. There is a subset labeled chronic pediatric patients who have medical issues that require frequent monitoring. The pediatrician with subspecialist consultation often follows these patients. They have diseases such as congenital adrenal hyperplasia, seizure disorder, pulmonary bronchiectasis, congenital hypothyroidism, septo-optic dysplasia and other syndromes, which are still undergoing evaluation. At times due to limitations in scheduling any provider available will see them in clinic. It is important to discuss these patients with more knowledgeable providers. | |
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| Overall we strive to create a medical home for all our patients both near and far. Through the help of departments such as physical therapy, diabetes, tobacco cessation, IMPACT and WIC programs we are able to provide resources to our patients to help them improve and maintain health.
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| '''Some clinical recommendations in a nutshell'''
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| * If you are drawing a CBC on a child for illness, always add a blood culture. | |
| * When doing an Incision and Drainage on an abscess, always obtain a wound culture.
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| * Draw a line around the redness of a cellulitis as a way to monitor it.
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| * Don’t treat children under 90 days with Antibiotics – w/o having them come to Bethel for a septic workup. | |
| '''Refer to the [[YKHC Guidelines]] and use them when appropriate for all patients. They lay out specific medical plans based on our populations challenging illnesses/and our resistance patterns.'''
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| ===Clinic Description===
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| The hospital complex encompasses the inpatient ward, outpatient clinics, surgery and emergency room. There are three outpatient clinics named Delta, Kusko and Yukon that are situated in three hallways adjacent to each other just inside the hospital complex. The three hallways have eight to nine rooms each and a central nursing station. In addition, there are two negative airflow rooms located in Delta and Yukon Clinics.
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| ===Job Description/Duties===
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| '''8 Hour Shift''': 9 a.m. – 6 p.m. approximately<br />
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| 9 a.m. – 12 p.m. > lunch > (RMT) > 1:20 p.m. – 6 p.m.
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| '''Non RMT Provider 8 Hour Shift''': 9 a.m. – 6 p.m.<br />
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| 9 a.m. – 12 p.m. > lunch > 1 p.m. – 6 p.m.
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| *Providers are exempt employees and are required to attend required meetings and work until patient care responsibilities are complete. Outpatient Clinic Meetings 8 a.m. on every third Monday and Interdisciplinary Rounds at 8 a.m. on Thursdays are mandatory. | |
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| Radio Medical Traffic (RMT): Mon-Fri. 10 a.m. – 6 p.m.<br />
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| One practitioner per group will be assigned to do group orphan RMT, assist clinic providers with RMT and help clinic with patient care as able. Continuity and back-up RMT support will be requested from provider staff on admin time first. Practitioners are required to attend regular scheduled meetings.
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| Admin: 9 a.m. – 6 p.m.<br />
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| Expected to work a regular workday, do continuity RMT, and attend required meetings. As a last resort, may be used as a jeopardy provider or other duties as assigned. Administration time is typically one half day twice per month.
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| Village Admin: Mon-Fri. 9 a.m. – 6 p.m. <br />
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| This day is given to a provider who has completed a 3 – 5-day village trip to complete charge sheets, charting, referrals and follow-up work. Expected to work a regular workday, do continuity RMT, and attend required meetings. As a last resort, may be used as a jeopardy provider to help with RMT, clinic or other duties as assigned.
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| ===[[Meetings]]=== [[link to medical staff meetings in resources]]
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