Criterion 1.1.1 Scheduling care in opening hours
Our service has a flexible system that enables us to accommodate patients with urgent, nonurgent, complex, planned chronic care, and preventive health needs.
► A. There is evidence that our service has a flexible system to accommodate patients with urgent, nonurgent, complex and planned chronic care, and preventive health needs (document review).
► B. Our staff can describe the way in which they identify urgent medical matters and their procedures for obtaining urgent medical attention (interview).
► C. Our service has a written policy for dealing with urgent medical matters (document review).
► D. Our service can demonstrate that patients can directly access the health service by telephone, written request, in person or other direct method during normal opening hours (direct observation).
The needs of patients vary widely and health services need to have flexible systems that can accommodate urgent, nonurgent, complex, planned chronic care and preventive health needs during normal opening hours.
There are times when patients need urgent access to primary medical care, and health services need to have systems that anticipate this need (eg. an appointment system could include reserving unbooked appointment times for patients with urgent medical needs). Patients also value the opportunity to see a GP or another member of the clinical team within a reasonable time for nonurgent and preventive health matters.
Health services need to be able to identify patients who have an urgent health need and facilitate care for them appropriately. The system used to identify patients with urgent needs has to be efficient and prompt. Medical, clinical and administrative staff need to be able to describe the service’s policy and procedures for identifying patients with urgent medical matters and the procedures for seeking urgent medical assistance from a clinical staff member. Staff also need to be able to describe how the health service deals with patients who have urgent medical needs when the health service is operating at full capacity (eg. when staff are fully occupied).
The Standard guidelines for corrections in Australia14 stipulate that a prisoner is to be medically examined by a suitably qualified health professional within 24 hours of being received into prison, and thereafter as necessary. This is a clinically important process (as opposed to a routine bureaucratic procedure) for determining whether the prisoner has health concerns (eg. acute or chronic illness, ongoing medication requirements, potential detoxification issues or suicide risk) that require immediate medical attention and management. Where necessary, and when the prisoner is likely to continue to be in custody in the prison, a follow up to the initial consultation in order to perform a comprehensive health assessment would be recommended within 48 hours of the prisoner’s arrival.
Length of individual consultations will vary according to clinical need. There is a body of evidence suggesting that longer consultation times are associated with better health outcomes and improved patient satisfaction. Much of the benefit is thought to arise from the improved communication between doctors and their patients that occurs in longer consultations. Research also suggests that preventive care, effective record keeping, patient satisfaction and patient participation in the consultation can be compromised when consultations are too short. Data from the Bettering the Evaluation and Care of Health (BEACH) study shows average consultation times in Australian general practice are around 14 minutes. Although there is no comparable data for consultation times within prison health services, it is noted that patients in prison are more likely to have chronic diseases and complex clinical needs necessitating longer consultation times.
The system for scheduling care needs to include longer consultations for people who have more complex clinical needs or if an interpreter is present. Staff need to have the skills and knowledge to assist in determining the most appropriate length and timing of consultations at the time of the request. Although it is difficult to predict how much time will be needed for a particular consultation, this criterion requires that health services have systems that endeavour to predict and meet this need.
Thus, key indicators for whether consultation times are long enough are not only duration, but other factors such as the adequacy of patient health records. Whether a health service meets this criterion may need to be seen in the context of other indicators in the health service. Assessment of this criterion needs to take into account the specific circumstances of the health service.
Health services that do not have a formal appointment system can meet this criterion if there is adequate communication on anticipated waiting times and if the service prioritises patients according to urgency of need.
It is important that prisoners normally have direct access to the health service to make an appointment and do not routinely have to rely on others, such as prison staff within the facility, to mediate their request for access to healthcare or to identify medical needs. It is not appropriate for prison staff to triage patients who request medical attention. Triage by clinical staff allows for greater assurances of confidentiality and privacy for prisoners as well as minimising any medicolegal risk to the health service that may arise from relying on nonhealth professionals to identify medical needs.
It may not be possible for prisoners to contact a health service by telephone to make an appointment, and written requests for an appointment could prove difficult for prisoners with low levels of literacy. Health services may therefore need to devise special strategies for prisoners to request an appointment. A method currently used in one health service is for each prisoner to have a card containing their name or prisoner number that can be placed in an appointment box. It is important for health services to document in a patient’s health record any delay between a request for healthcare and the provision of that healthcare, including the reason for the delay.