health assessment is a considerable deficiency. Sick Call The sick call process is the backbone of a correctional health system. NCCHC standards and most state penal codes require a formal sick call process with daily inmate access. While we commend CT DOC for undertaking a sick call change process in the piloting of Prompt Care (PC) and acknowledge strengths in 16 the existing system such as timely follow‐up to sick call orders, the current state of the CT DOC sick call practice has significant limitations. The PC process was designed to overcome process shortcomings and increase access. The goals were laudable, but overall PC has not been successful because of the following: · Sick call access remains an issue due to provider shortages · The system is confusing to inmates · PC is not accountable · PC was not conceived under a larger set of policy goals that could be met with resources, codified, and scaled. More specifically, the current state of CT DOC sick call: · Lacks uniformity and standardization across the system · Is driven by “provider busyness” and staffing levels · Lacks a dedicated request form; the current request form is not sufficiently specific to sick call as it conflates with inmate grievances · Lacks a uniform data set reflecting inmate access to sick call · Is not audited for quality/compliance/performance · Does not seem to be driven on nursing protocols · Lacks safeguards to ensure requests do not get “lost” due to bumping or multiple requests · Tends to allow providers to address chronic conditions in the context of sick call; this contributes to poor chronic care service documentation in the EHR, so chronic care management cannot be appropriately evaluated. In our assessment, the CT DOC sick call process needs an overhaul across the entire system. A key starting point would be updating the Sick Call Policy (8.1.6.A) to provide detail for the methods to access the sick call process, the triage process, or timeframes for response to requests and for sick call encounters. Our proposed model of care includes key sick call elements that provide a basis for beginning this work. As an additional resource, an HMA issue brief, “Best Practices in Managing Sick Call”, is included as Appendix 4. Below are brief highlights of the elements of a well‐performing correctional setting sick call program: · All inmates, regardless of housing assignment, are given the opportunity to submit oral or written health care requests at least daily. · Inmates must be able to submit confidential sick call requests. · Sick call requests are picked up at least once daily. · Sick call requests are triaged by a qualified health professional within 24 hours of receipt. Recommendation 17 o Often this is completed on night shift along with the population of sick call roster for nursing and the provider. o All requests with clinical elements must be evaluated by a qualified health professional face‐to‐face within 24 hours. · Providers adhere to specific timeframes in following up with all nurse referrals: o Emergent needs are seen the same day. o Urgent needs are seen within 1‐2 days. · Patients are evaluated in a clinical setting. · The program utilizes strong nursing protocols for management of many of the common sick call complaints. · The program demonstrates fidelity to nursing protocols, which must be monitored through audit and follow‐up training. · Scheduling of sick call nurse and provider visits, which was not reviewed, are central to any efficient and effectively run sick call process. Critical issues include, but are not limited to: o The number of visits a given provider will “allow” during a day o Tracking and managing rescheduled sick calls or “bumping” o Ensuring required provider visits are scheduled (e.g. when an inmate makes multiple sick call requests about the same complaint.) · All aspects of the health care request process, from review and prioritization to subsequent encounter, are documented, dated, and timed. · The frequency and duration of response to health services requests are sufficient to meet the health needs of the patient population. · Continuous Quality Improvement (CQI) efforts will include, but are not limited to, compliance with policies and procedures. Tracking and reporting on key sick call performance metrics help identify opportunities for improvement and further training; for example, an assessment of nurse encounters that results in a provider referral can detect any significant variance across the nursing staff and may indicate the need for additional training and supervisory intervention. Periodic Health Assessment CT DOC policy on periodic health assessments (Directive 8.1.8.G) states that “each inmate shall receive a periodic health assessment as determined by the responsible physician.” Periodic health assessments are another fundamental component of correctional health care. This affords the opportunity to conduct age and gender‐appropriate preventive care and capture any new conditions in a comprehensive treatment plan that were not identified/addressed in the intake assessment. While the CT DOC Directive clearly contemplates periodic health assessments, it is limited in its ability to drive patient wellness because the policy and practice lacks timeframes, prompts, and guidelines. Guidelines might include requiring assessment whenever there is a change in condition, as a scheduled 18 part of clinical follow‐up or a