Overview

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 that are staffed by Family Medicine, Women’s Health, OB GYN, and Pediatric physicians and midlevel providers. There is also a Specialty Clinic where a variety visiting specialists, who are each scheduled ‘field clinics’ 2-6 times a year. Specialty clinics include ENT, Surgery, and Ortho physicians who provide adult and pediatric care; adult and pediatric neurologists and cardiologists as well as pediatric endocrinologist and pulmonologist clinics. All clinics are scheduled M-F 9-5pm.

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 appts 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.

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 ten 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. 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 a specialist and find themselves needing to contact several sub specialists during the day. There are 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 sub-speciailsts. It is important to talk to other experienced Bethel providers and consult about any complicated patients.

Contents

Clinic Description

Job Description / Duties (clinic)

Required and Recommended Meetings

Preparing For and Navigating Daily Clinics

Clinic Appointments/Encounters

• Well Visits
  • Adults
  • Pediatrics
• Sick Visits
• ER Rechecks
• Chronic Pain Visits
• Behavioral Health
• Domestic Violence
• Ortho
• Procedures
• Women's Health
• Tobacco Cessation
• Pre-Ops
• Admitting a Patient From Clinic to Inpatient
• Clinic to ER Transfers
• Clinic Transfer/Medevac to Other Facility

Pediatrician Clinics

• Overview
• Pediatrician Specific Encounters

Clinic Case Management

Clinic Documentation in RAVEN

Regular RMT

Bethel Based Specialty Clinics and Services

• Overview of What is Available
• Dental
• Optometry
• Surgery
• Ortho
• ENT
• Adult Cardiology
• Pediatric Cardiology
• Adult Neurology
• Pediatric Neurology
• Pediatric Pulmonology
• Pediatric Endocrinology

Outside Specialty Clinics and Services

• Overview of What is Available
• Dental
• Ophthalmology
• Surgery
• Ortho
• ENT
• OB/GYN
• Adult Ophthalmology
• Pediatric Ophthalmology
• Adult Internal Medicine
• Adult Hematology and Oncology
• Pediatric Hematology and Oncology
• Adult Cardiology
• Pediatric Cardiology
• Adult Neurology
• Pediatric Neurology
• Pediatric Pulmonology
• Pediatric Endocrinology
• Allergy and Immunology

How to Refer for Specialty Clinics and Services

• RAVEN
• e-Referrals
• Paper

Village Trips

Telemedicine

Outpatient Ancillary Services

• Lab
• Radiology
• Pharmacy
• Respiratory / Cardiopulmonary Services
• Physical Therapy
• Wound Care
• Diabetes
• Social Services
• Tobacco Cessation
• Dietary
• WIC
• Community Relations/Translation

Bethel Consult Services

• Pediatric
• High Risk OB (HROB)
• Dental
• Optometry
• TB
• Breast Feeding
• HIV

Outside Consult Services

• ANMC Specialists
• Radiology
• TB
• HIV
• Poison Control
• Seattle Children’s Hospital Specialty Consult Line
• MEDCON Adult and Pediatric Specialty Consult Line
• Pathology

Guidelines for Outpatient Medicine

• Type 2 Diabetes
• Boils — Outpatient
• GERD
• Tuberculosis
• Hypertension
• Colorectal Cancer Screening
• Chronic Pain
• Post Acute Myocardial Infarction (AMI)
• Breast Cancer Screening
• IV Iron
• Quick Start Guideline
• PAP Smear Screening Guidelines
• YKHC Abnormal Cytology Guideline
• Cervical Cancer Screening Guideline
• Pre-Anesthesia Testing
• Latent Tuberculosis Bacterial Infection (LBTI)

• Prenatal

Unique/Common YK Delta Diseases—see Bush ABCs

Teamwork-Outpatient