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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. |
| YKHC Outpatient clinics provide care for approx. 6,000 Bethel patients as well as another 22,000 patients who come in from 48 surrounding villages. The outpatient clinics are busy and provide about 45,000 visits a year. The outpatient clinics are staffed by Family Medicine, Women’s Health, OB GYN, and Pediatric physicians and midlevel providers.
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| Approximately 50% of the clinic volume is made up of village patients who have arrived by plane, boat, snow machine, river taxi, or hovercraft. Village patients often arrive early or late for scheduled appointments because of plane schedules and weather, etc. Village patients do not get seen often in Bethel because they have less access to our Bethel clinics due to the cost of travel, weather, work or personal responsibilities in their village. Because it is harder for village patients to get into Bethel for care, often providers will try to get as much done as possible in each visit. The other 50% of the clinic appointments are Bethel patients, who are seen more frequently and come into clinic an average of 6 times a year.
| | ==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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| Our clinic patients are generally sicker and have a higher acuity than patients normally seen in Lower 48 outpatient clinic settings. This population is highly susceptible to bacterial and viral infections. We have 10 times the rate of strep pneumococcus, which leads to more septic workups in neonates and increased amounts of pneumonia for the entire Delta. There is rampant TB in villages intermittently, invasive HiB and HiA infections, MRSA boils and RSV is a huge problem.
| | ==COMMON OUTPATIENT ENCOUNTERS== |
| | | *[[Clinic Appointments/Encounters|Common Outpatient Encounters]] |
| Health Aides in villages have already prescreened 50% of the patients seen in the Bethel clinics and only the sicker ones have been sent on to Bethel. These sicker patients are more complex and time consuming. They often require more evaluation and treatment than other clinic patients. It is not unusual for clinic providers to function like specialists and find themselves needing to contact several subspecialists during the day. There is also a registry of about a thousand chronically ill pediatric patients (CPP patients) that are primarily managed and seen in clinic by the pediatric providers. These patients are sicker than most pediatric patients and may be followed by pediatric subspeciailsts. It is important to talk to other experienced Bethel providers and consult about any complicated patients.
| | *[[Specific Types of Appointments and Procedural Processes|Outpatient Pediatric Encounters]] |
| | | *[[Common Outpatient Procedures]] |
| Patients are also often followed in clinic for several days while rooming at the Hostel. For example: a patient requiring IV antibiotics for pneumonia will often receive several days of IV Ceftriaxone prior to switching to oral on an outpatient basis. Unless a pneumonia patient requires oxygen, IV fluid, or looks septic they will not be admitted. Patients that would often be an automatic admit in the Lower 48 may be treated as an outpatient in Bethel. Check with experienced providers before admitting a patient from clinic until you are familiar with our system. Remember that some simple follow-ups are appropriately handled by the health aid in the village. For example, a patient need not return to Bethel for an otitis media follow-up exam. This can be done by the Health Aide in the village. The Health Aides are a great resource, so remember to use them if appropriate.
| | *[[Immunizations/Well Child]] |
| | | *[[Outpatient Clinic Introduction#Medication Refills|Medication Refills]] |
| =Contents= | | *[[Regular (Outpatient) RMT|Outpatient RMT Common Scenarios]] |
| | | *[[Outpatient RMT Workflow]] |
| [[Clinic Description]]
| | *[[:Category:YKHC Guidelines#Outpatient Guidelines|Outpatient YKHC Clinical Guidelines]] |
| | | *[[INTRA and INTERhospital Transfers|Admissions and Transfers]] |
| [[Job Description / Duties (clinic)]]
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| [[Required and Recommended Meetings]]
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| [[medevacs#formularies|formularies]]
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| [[Preparing For and Navigating Daily Clinics]]
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| [[Clinic Appointments/Encounters]] | |
| *[[Clinic_Appointments/Encounters#Well_Visits|Well Visits]]
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| **Adults
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| **Pediatrics
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| *Sick Visits
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| *ER Rechecks
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| *[[Clinic_Appointments/Encounters#Chronic_Pain|Chronic Pain Visits]]
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| *[[Clinic_Appointments/Encounters#Behavioral Health|Behavioral Health]] | |
| *[[Clinic_Appointments/Encounters#Domestic Violence|Domestic Violence]]
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| *[[Clinic_Appointments/Encounters#Ortho|Ortho]]
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| *[[Clinic_Appointments/Encounters#Procedures|Procedures]] | |
| *[[Clinic_Appointments/Encounters#Women’s Health|Women's Health]] | |
| *[[Clinic_Appointments/Encounters#Tobacco Cessation|Tobacco Cessation]] | |
| *[[Clinic_Appointments/Encounters#Pre-Ops|Pre-Ops]]
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| *[[Clinic_Appointments/Encounters#Admitting a Patient from Clinic to Inpatient|Admitting a Patient From Clinic to Inpatient]]
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| *[[Clinic_Appointments/Encounters#Clinic to ER Transfers|Clinic to ER Transfers]]
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| *[[Clinic_Appointments/Encounters#Clinic Transfer/Medevac to Other Facility|Clinic Transfer/Medevac to Other Facility]] | |
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| [[Pediatric Clinics|Pediatrician Clinics]]
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| *Overview
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| *Pediatrician Specific Encounters
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| [[Clinic Case Management]]
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| [[Clinic Documentation in RAVEN]]
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| [[Regular RMT]]
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| [[Bethel Based Specialty Clinics and Services]]
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| *Overview of What is Available
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| *Dental
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| *Optometry
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| *Surgery
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| *Ortho
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| *ENT
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| *Adult Cardiology
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| *Pediatric Cardiology
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| *Adult Neurology | |
| *Pediatric Neurology
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| *Pediatric Pulmonology
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| *Pediatric Endocrinology
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| [[Outside Specialty Clinics and Services]]
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| *Overview of What is Available
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| *Dental
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| *Ophthalmology
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| *Surgery
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| *Ortho
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| *ENT
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| *OB/GYN
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| *Adult Ophthalmology
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| *Pediatric Ophthalmology
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| *Adult Internal Medicine
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| *Adult Hematology and Oncology
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| *Pediatric Hematology and Oncology
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| *Adult Cardiology
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| *Pediatric Cardiology
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| *Adult Neurology
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| *Pediatric Neurology
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| *Pediatric Pulmonology
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| *Pediatric Endocrinology
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| *Allergy and Immunology
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| [[How to Refer for Specialty Clinics and Services]]
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| *RAVEN
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| *e-Referrals
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| *Paper
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| [[Village Trips]]
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| [[Telemedicine]]
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| [[Outpatient Ancillary Services]] | |
| *Lab
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| *Radiology
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| *[[Outpatient_Ancillary_Services#Pharmacy|Pharmacy]] | |
| * [[Outpatient_Ancillary_Services#Respiratory_/_Cardiopulmonary Services|Respiratory / Cardiopulmonary Services]] | |
| *Physical Therapy
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| * Wound Care
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| * Diabetes
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| * Social Services
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| * Tobacco Cessation
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| * Dietary
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| * WIC
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| * Community Relations/Translation
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| [[Bethel Consult Services]]
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| *Pediatric
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| *High Risk OB (HROB)
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| *Dental
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| *Optometry
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| *TB
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| *Breast Feeding
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| *HIV
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| [[Outside Consult Services]]
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| *ANMC Specialists
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| *Radiology
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| *TB
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| *HIV
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| *Poison Control
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| *Seattle Children’s Hospital Specialty Consult Line
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| *MEDCON Adult and Pediatric Specialty Consult Line
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| *Pathology
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| Outpatient Guidelines
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| * Outpatient Guidelines
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| **Type 2 Diabetes
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| **Boils-Outpatient
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| **GERD
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| **Tuberculosis
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| **Hypertension
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| **Colorectal Cancer Screening
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| **Chronic Pain
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| **Post Acute Myocardial Infarction (AMI)
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| **Breast Cancer Screening
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| **IV Iron
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| **Quick Start Guideline
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| **PAP Smear Screening Guidelines
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| **YKHC Abnormal Cytology Guideline
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| **Cervical Cancer Screening Guideline
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| **Pre-Anesthesia Testing
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| **Latent Tuberculosis Bacterial Infection (LBTI)
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| *OB Guidelines-Prenatal
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| **First Trimester Vaginal Bleeding
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| **Fetal Fibronectin in PTL
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| **Gestational Diabetes
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| **High Resolution OB Ultrasound Referral
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| **Preterm Labor-Bethel
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| **Molar Pregnancy
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| **Anemia in Pregnanacy
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| **Gestational Hypertension
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| **Anti-D Immune Globulin
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| **Intrauterine Growth Restriction (IUGR)
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| **Oligohydramnios
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| **Post Dates Pregnancy
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| **Induction of Labor
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| **Intrahepatic Cholestasis of Pregnancy
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| **Chronic Hypertension in Pregnancy
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| *Pediatric Guidelines-Outpatient
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| **Fever > 100.4
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| **Febrile UTI in Infants and Children
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| **First Non-Febrile Seizure
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| **First Febrile Seizure
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| **Hyperbilirubinemia/Jaundice
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| **Otitis Media
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| **Initiation of ADHD Medications
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| **Restarting ADHD Medications
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| **ADHD Medication Refills
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| **Developmental Dysplasia of the Hip
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| **Child/Adolescent Sexual Assault
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| **Community Acquired Pneumonia (CAP) Pediatrics > 3 Months Evaluation &Treatment
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| Unique/Common YK Delta Diseases—see Bush ABCs
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| [[Teamwork-Outpatient]]
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