Decreasing Lines at Care-A-Van Clinic Sites
Alesia Giller, Anastasia Gordea, Brooke Hettinger, Megan Apollonio and Ashley Kelejian
Bon Secours Memorial College of Nursing
Abstract
QI Project Objectives
Title: Decreasing Lines at Care-A-Van Clinic Sites
Introduction:
Due to a multitude of factors including language
barriers, minimal resources and limited staff, our
group sought to discover a solution which would
further decrease the long lines as well as increase
fluidity and efficiency of care.
Conclusion:
For the purpose of decreasing long lines at the
Care-A-Van, we have proposed a comprehensive
solution which includes both the addition of a
clinical role, as well as the inclusion of technology
such as pre-recorded messages. Implementing our
designated model will further decrease the length
of the lines as well as increase comprehension
regarding offered services and care.
Introduction and Description of
the Issue
Macro Description:
Overall healthcare coverage (absence or shortage), represents a
huge macro contributor to the problem at hand.
Over 1.8 million people in the United States are recorded to be
searching for free clinic accessibility as a result of lack of
coverage/affordability (Sessions, Hassan, Mcleod, & Wieland,
2017).
According to the American Community Survey (ACV) 2018 report,
an estimated 718,000 Virginians under the age of 65 do not have
health insurance (Skopec & Aarons, 2018).
Micro Description:
The Care-A-Van has limited consistent accessibility per location.
The Care-A-Van also has limited means of language accessibility
services per location.
Determinants such as low literacy and other language barriers act
as an obstacle within the system, keeping clients from both
receiving and accessing care when needed.
Data and Analysis of the Issue
Unsuccessful bridge of communication between
clients and staff pertaining to both availability and
access. The key elements of this issue at stake
include the language barrier, low literacy , deficit of
internet access, minimal capacity, limited funding
and inconsistent site rotation.
Root Cause
Limiting resources vs increased demand:
• Care-A-Van is unable to provide offered
resources due to increasing demand.
• Inadequate staffing and resources per site to
meet the growing needs of the population
seeking treatment.
Undocumented population seeking care:
• Do not have insurance
• Cannot apply for healthcare coverage
• Unable to refer for CHIP, Medicare
• Undocumented population afraid of potential
deportation
Literacy and Education:
• Multilingual language barrier (dialect)
• Insufficient medical records (incomplete,
untranslated, or absence of documents)
Proposed
ProposedSolution
Solution Conclusion
Through our proposed interventions we are
Short-Term: confident we have provided a viable solution to
Pre-recorded message on the Care-A-Van phone line with the
resolve the main issue of over-populated lines at
accessibility information, date, time, and location of the next
scheduled clinic. This phone line will be open two hours prior to the Care-A-Van. While the phone operating system
the clinic opening. The message will be pre-recorded in English works to provide short-term relief, our proposed
and Spanish and will take the place of the website calendar triaging system will work in tandem to further
posting.
Long-Term:
eliminate the long-term issues at hand.
1. Triaging those in line for emergent vs. non-emergent care.
2. Screen population for those who qualify for CHIP, Medicare,
other Financial Assistance, and Charity Care
Logistics
• Hire FTE to provide available resources and screen for financial resources
• Resources: Templates, Education, Applications
Stakeholders
• Care-A-Van
• Bon Secours Health Systems
• Patients
• Medical staff
•
•
Local clinics
Community resources (Urgent care, ED)
References
Potential costs Sessions, K., Hassan, A., Mcleod, T. G., & Wieland, M. L. (2017).
Health Insurance Status and Eligibility Among Patients who Seek
• Hiring Case Manager ($40,000 a year)
• Printable resources/applications ($240 for paper and
Healthcare at a Free Clinic in the Affordable Care Act Era. Journal
of Community Health, 43(2), 263–267. doi: 10.1007/s10900-017-
printer cartridge)
• Pre-recorded phone line (no cost)
0414-8
Skopec, L. & Aarons, J. (2018). A profile of Virginia’s uninsured,
2016. Retrieved September 10, 2019, from
Timeline http://www.vhcf.org/wp-content/uploads/2018/03/Profile-of-
Virginias-Uninsured-28Feb2018.pdf.
• 0-6 months: Pre-record message, change website
calendar, hire and train Case Manager
• 6 months: Implement the new process
• 12-18 months: Evaluate process and implement
proposed changes
Data Collection
• Patient survey
• Evaluate the presence of line
• Observational data
• Staff evaluation on implementing process and workload