Nonemergency Health Care Requests

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When conducting sick call and a face-to-face encounter is required, should the encounter occur within 48 hours of (a) picking up the request or (b) triaging the request?

Standard E-07 Nonemergency Health Care Requests and Services requires that oral or written requests for health care are picked up daily by qualified health care professionals and triaged within 24 hours. When a request describes a clinical symptom, a face-to-face encounter between the patient and a qualified health care professional occurs within 48 hours (72 hours on weekends). The intent is that a patient is seen within 48 hours (72 hours on weekends) from the time the request is picked up. The requests should be triaged in the first 24 hours and the face-to-face encounter should be conducted within the next 24 hours.

From CorrectCare Volume 31, Issue 3, Summer 2017

 
 

Our jail is developing a continuous quality improvement rubric to be used by our contract monitor with regard to nonemergency health care requests and services (standard E-07). We are measuring the time between receipt of the sick-call slip and when someone actually is seen. Compliance indicator #1 states that inmates who describe clinical symptoms should be seen face to face by a professional within 48 hours (72 on weekends). If the slip is triaged within 24 hours, does that time count toward the 48 hours, requiring the person to be seen the next day? Or does the “clock” start over again and we have an additional 48 hours after it is triaged to have the patient seen by a provider? Our contract monitor is using the interpretation of 48 hours from receipt of the slip, which has generated the debate that it is unreasonable to expect a face-to-face encounter within 24 hours of assigning it to a provider.

Upon receipt of a written request for health care, it must be triaged within 24 hours and if the request describes a clinical symptom, a face-to-face encounter with a qualified health care professional must occur within 48 hours from receipt of the written request. The “clock” does not start over again after triage. Your question also refers to the need for the patient to be seen by a “provider,” which is normally a physician or midlevel provider. The standard says that the encounter must be with a “qualified health care professional,” which also includes nurses. Please see the glossary for a definition of who is considered qualified health care professionals.
From CorrectCare Volume 29, Issue 2, Spring 2015

 
 

My question relates to standard E-07 Nonemergency Health Care Requests and Services. Our facility uses electronic kiosks in each housing unit. If patients are allowed to submit one medical request daily, one mental health request daily and one dental request daily, are we meeting the standard? Currently there is no limit and the nursing staff is struggling to keep up with answering them within 24 hours because some of the inmates are placing up to 10 requests per day.

This standard intends that inmates’ routine health care needs are met. Therefore, facilities should not limit the number of health care requests an inmate can make. However, if the requests are for the same issue, it is not necessary to respond to all of them.
From CorrectCare Volume 28, Issue 4, Fall 2014

 
 

In the 2014 Standards, E-07 Nonemergency Health Care Requests and Services says that oral or written requests for health care are picked up daily by qualified health care professionals and triaged within 24 hours. When a request describes a clinical symptom, a face-to-face encounter occurs within 48 hours (72 hours on weekends). Does this mean that we now have two days to see a patient once the request has been triaged?

No. The 48-hour time frame begins upon receipt of the written or oral health care request. Triage is required within 24 hours and a face-to-face assessment (when the request describes a clinical symptom) by a qualified health care professional is required within the next 24 hours. This is applicable for all medical, dental and mental health requests.
From CorrectCare Volume 28, Issue 2, Spring 2014

 
 

If an inmate wants to see the dentist for a cleaning or filling and is experiencing no pain, and thus does not want or need a nurse to evaluate the need, do the standards require the nurse to see the patient before letting the patient see the dentist?

There are a couple of standards that must be considered. Standard J-E-06 Oral Care requires that oral treatment, not limited to extractions, is provided according to a treatment plan based on a system of established priorities for care when, in the dentist’s judgment, the inmate’s health would otherwise be adversely affected. Standard J-E-07 Nonemergency Health Care Requests and Services requires that oral or written requests for health care are received daily by qualified health care professionals and triaged within 24 hours. Based on physician-approved protocols, qualified health care professionals schedule inmates, when indicated, for sick call or the next available clinician’s clinic. Not every sick call request requires a sick call appointment; however, when a request describes a clinical symptom, a face-to-face encounter between the inmate and the health care professional is required.

If the request you described does not include a clinical symptom, then a face-to-face visit would not be required by the Standards. I would advise working closely with the dentist at your facility to determine the appropriate response to requests for fillings or cleanings.

From CorrectCare Volume 28, Issue 1, Winter 2014

 
 

I am the interim clinical manager in a jail. We currently use a triage system in which inmates submit a written paper to request services. We have been doing a pilot program where we send a nurse to the women’s pod five days a week to respond to general, nonemergent requests for services (colds, medication refills, minor symptoms, etc.). We also have an urgent care area that would handle emergent situations. We would like to do this with all of our pods. In reviewing the jail standards, I believe this would meet standards, but before we proceed, we would like your input.

Having a nurse triage complaints directly at the housing unit is certainly an acceptable method. However, three caveats must be considered. The first is access. Consider this triage system for seven days a week instead of five. If you plan to use a bifurcated system (personal triage Monday through Friday, written slips Saturday and Sunday), you may be creating some problems for access. Bifurcated systems are confusing for staff and inmates and may increase the risk of someone not being able to get their health needs known during the weekend. The second caveat is documentation. The standard requires that inmate requests are documented, so the triaging nurse needs to maintain a log of triaged complaints. The third caveat is privacy. All due caution should be taken to ensure that the triage encounter is performed with some privacy so that the inmate feels unencumbered when relating his or her health issues.
From CorrectCare Volume 26, Issue 4, Fall 2012

 
 

We have an inmate who frequently complains about the same chronic problem (a bad back) and asks to be seen by the physician. Can we schedule a monthly check up with the physician and deny the inmate’s other requests to see a physician about this condition?

The standards do not address how frequently an individual must be seen for a particular condition. That decision rests with the treating clinician. If the clinician wishes to schedule monthly check ups for this patient, he/she should write the order accordingly. The standards do state that inmates must have an opportunity daily to request medical assistance and that their requests must be triaged and acted upon as appropriate (E-07 Nonemergency Health Care Requests and Services). This does not mean, however, that an inmate must be seen each time he/she makes a request. In your case, I would suggest that each time this inmate makes a request, you bring it to the attention of the treating clinician and let him/her decide whether the patient needs to be seen and, if so, when. If the clinician determines the patient does not need to be seen until the next scheduled visit, that information should be communicated to the patient exactly that way (e.g., “Dr. Jones says she will see you at your next scheduled visit on Jan. 15”).
— From CorrectCare Volume 22, Issue 4, Fall 2008