RESUMEN
Many health systems employ nurse telephone advice services to facilitate remote triage of patients to appropriate level of care. However, the effectiveness of these programs to reduce ED and subsequent health care utilization remains to be demonstrated. We describe a novel virtual urgent care program implemented within a Veterans Affairs (VA) health care system that interfaces with a nurse telephone advice line and leverages telemedicine tools to rapidly address and resolve nonemergent conditions. During a 4-month pilot period, 104 unique patients received care through the program, and over 85% of patients achieved timely resolution for their urgent complaints on first contact with the health care system. Demonstrating feasibility for such a program has potential implications for the optimization of remote triage and urgent care services to improve health care utilization and outcomes.
Asunto(s)
Diente Premolar/lesiones , Enfermedades de los Bovinos/diagnóstico por imagen , Fracturas Espontáneas/veterinaria , Fracturas de los Dientes/veterinaria , Absceso/complicaciones , Absceso/microbiología , Absceso/veterinaria , Infecciones por Actinomycetales/diagnóstico por imagen , Infecciones por Actinomycetales/patología , Infecciones por Actinomycetales/veterinaria , Animales , Arcanobacterium/aislamiento & purificación , Bovinos , Enfermedades de los Bovinos/patología , Enfermedades de los Bovinos/cirugía , Diagnóstico Diferencial , Femenino , Fracturas Espontáneas/diagnóstico por imagen , Fracturas Espontáneas/patología , Fracturas Espontáneas/terapia , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Mandibulares/patología , Enfermedades Mandibulares/terapia , Enfermedades Mandibulares/veterinaria , Radiografía , Fracturas de los Dientes/diagnóstico por imagen , Fracturas de los Dientes/patología , Fracturas de los Dientes/terapia , Raíz del Diente/microbiología , Raíz del Diente/patologíaRESUMEN
The value of continuity in medical education, particularly during clerkships, is increasingly recognized. Previous clerkship-based models have described changes that emphasize continuity in patient care, learner supervision, and curriculum. The creation of continuous student peer groups can foster interactions that enhance mutual support through uncomfortable professional transitions during the clerkship years. Here, the authors describe a third-year clerkship model based at the San Francisco Veterans Affairs (VA) Medical Center called VA Longitudinal Rotations (VALOR), designed explicitly to establish a supportive learning environment for small peer groups.Seven groups of medical students (42 total) completed VALOR across three academic years between 2007 and 2009. On clerkships during VALOR, one hour per week was designated for faculty-facilitated sessions amongst peer groups. Students' perceptions of peer group support and overall program satisfaction were determined with immediate post surveys and focus groups at the end of VALOR, and with follow-up surveys 5 to 27 months after completing VALOR. Students strongly valued several elements of VALOR peer groups, including support through clerkship challenges, meeting for facilitated reflection, and appreciating patient experiences across the continuum of care. Students' appreciation for their peer group experiences persisted well after the conclusion of VALOR. VALOR students performed the same as or better than traditional clerkship students on knowledge and skill-based outcomes. The authors demonstrate that their third-year clerkship program using peer groups has built supportive learning networks and facilitated reflection, allowing students to develop critical professional skills. Student communication around patient care was also feasible and highly valued.