begun to revamp 6 the Utilization Management process for specialty care to ensure those who need specialty care are able to receive it in expeditious manner. Discussions have also started to improve efficiency and timeliness of HSU third party administrative functions like off‐site claims administration. Implementation of an electronic health record (EHR) system will allow HSU to closely monitor patient care, outcomes, and provider and system performance. As reporting functions become more robust, dashboards and patient registries will enhance operations and patient care. The electronic medication administration record (eMAR) also affords considerable opportunities to reduce medication administration errors, med line times, missed medications, and more. CT DOC should be lauded for a partnership with its sister agency, Department of Mental Health and Addiction Services, and a private contractor for offenders needing nursing home level of care and end of life care (60 West). Areas for Improvement: Operations and Administrative Functions CT DOC does not conduct initial health assessments within two weeks of incarceration by policy or practice. This is a clear departure from accreditation standards and creates risk for many conditions that are not identified in the chaotic intake screening environment. CT DOC also does not have a policy to conduct annual/periodic health assessments for high‐risk inmates. Periodic health assessments present the opportunity to conduct age and gender‐appropriate health screenings and immunizations which are vital to managing the health status of the CT DOC population. CT DOC’s sick call process is under‐developed and insufficiently monitored. The piloted sick call model, “Prompt Care,” does not address the fundamental components of sick call. HSU needs to redesign the full sick call system to standardize access, provider allocation, nursing protocols, documentation, and monitoring. CT DOC does not have an effective chronic care program by policy or practice. Providers often address chronic conditions during visits for other complaints, but the subsequent documentation is not recorded in a chronic care template and therefore cannot be monitored. Infirmary bed management across the system can improve to ensure infirmary beds are used only for those with clinical acuity and who need around‐the clock levels of clinical care level of care as opposed to infirmaries functioning as “locations.” The use of off‐site specialty care is not subject to acceptable utilization management review or to requirements for the components of a “good” referral to specialists. There are opportunities to enhance primary care management, the effectiveness of the specialty intervention, and tracking of patients awaiting specialty referrals to reduce poor outcomes and incomplete referrals. Offenders who need emergency department and inpatient care are receiving that level of care. The system lacks assurance of compliance with discharge instructions upon the offender’s return to the 7 correctional facility. It also lacks analysis of the appropriateness of emergency and inpatient care and variance across facilities and providers in the use of these levels of care. HSU administrative functions should follow the results and recommendations from this assessment. This includes strategic planning, development of policies and procedures, and development of clinical nursing protocols for sick call and emergencies. These should be consistent with relevant industry accreditation standards and Medicaid practices. CT DOC will need to develop a broad, measurement driven quality assurance (QA) program that is informed by real time and actionable metrics. CT DOC’s EHR implementation is incomplete in terms of provider use of templates, refinements to improve provider productivity, and reporting capabilities. The population health management capabilities of an EHR are not being realized. Areas for Improvement: Staffing The CT DOC staffing assessment was significantly limited by our inability to conduct site visits due to COVID‐19. We were not able to assess the degree to which HSU staff across the system are occupied, working at the top of their licenses, or interacting effectively. Nevertheless, interviews and document and medical chart reviews allowed for several staffing findings: · CT DOC does not have a single source document that illustrates budgeted staffing by discipline, shift, and facility. Such a document would show vacancies, their duration, and positions filled by locum or staffing agencies, which would provide a useful snapshot to leadership. · One comparison of CT DOC health care staffing to other prison systems shows fewer providers and more nurses per inmate than other systems. The data is from 2015 and therefore precedes the departure of UConn’s management of medical services. · Elimination of the facility‐specific Health Services Administrator has created a vacuum in local operation intel and hands‐on management. Managing daily priorities has fallen on nursing leaders to the detriment of their other duties. · Staff supervision and professional development, alignment of compensation with community standards, as well as competitive and attractive retirement benefits are several strategies worthy of consideration to positively impact staff morale and retention. 8