Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #115351

Mary Driscoll, RN, MPH¹, Gwen Harmon, RN², Barbara Fischer, RN³, Marietta Mendiola, RN³, Ann Muhammed, RN³, Chris Recker, RN, MPH³, Iris Thomas, RN³, and Marissa Villanueva, RN³. (1) Cook County Ambulatory Health Network, Hektoen, 1835 W Harrison Street, Suite 2204, Chicag, IL 60612, 312-400-5319, driscoll@hektoen.org, (2) Cook County Ambulatory Health Network, Cook County Bureau of Health Services, 1901 W. Harrison, Suite 1222, Chicago, IL 60612, (3) Referral Support Center, Cook County Bureau of Health Services, 627 S. Wood Street, Ste. 215, Chicago, IL 60612

Current research indicates that access to specialty care is becoming a pressing public health problem for the uninsured and underinsured. The Cook County Bureau of Health Services (CCBHS) is currently providing specialty care for 24 safety net partners. The partnership was developed to enhance access to scarce specialty resources for this vulnerable population. Nurses are playing an innovative role in supporting an electronic system which coordinates and tracks referrals from primary care to specialty care and diagnostics. A key feature of the system has been the development of specialty clinic entrance rules which prioritize patients clinically, ensure appropriate diagnostic workup, and provide educational guidelines based on “best practices” to keep patients appropriately managed in primary care. This system is receiving approximately 10,000 referrals per month and services 195 clinical sites. Working collaboratively with specifically designated specialist liaisons, nurses are refining specialty clinic entrance protocols, providing a resource for triage and review of escalated referrals previously rejected, and facilitating continuity of care between primary and specialty providers. They have become key players in helping to educate primary care providers in best practice guidelines embedded in rules, enhancing dialogue between primary and specialty care providers, and improving continuity of care. They ensure patients are triaged and scheduled for appointments appropriately, surface operational inefficiencies and capacity limitations within the specialties, and provide the clinical quality oversight necessary for this large electronic referral system. This new role merges public health and primary care nursing principles. The nurse must be aware of both population based approaches to health care combined with clinical expertise in ambulatory care.

Learning Objectives:

• Describe a new role for nursing which facilitates access to specialty care in safety net organizations.
• Articulate the significance of specialty clinic entrance rules and the nurses role supporting this triage mechanism in public health.
• Discuss the nurses role in clinical quality oversight of an electronic specialty referral system for the safety net.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation