This paper demonstrated that a nurse-led walk-in center model could transform and improve primary care delivery among underserved rural residents in Kentucky. The model is robust and evaluated from multiple perspectives to determine its effectiveness.
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An Overview: Walk-in Center
In any healthcare system, primary care remains a vital point of the first contact. Developed countries tend to offer better primary healthcare systems at relatively affordable costs and may attain enhanced healthcare outcomes. On the contrary, most countries or marginalized rural or urban settings now encounter nurse shortages, can hardly provide timely, affordable care and, thus, they always strive for novel ways to deliver primary care by enhancing the deployment of nursing and other supporting healthcare professionals and lessening reliance on medical practitioners. Countries, such as the US, the UK, France, and Canada have adopted primary care walk-in centers, which are led by nurses and other healthcare professionals (Mason et al., 2014).
This paper presented a walk-in center model as an innovative nursing care delivery tool to improve healthcare delivery and outcomes in general populations in poor, rural underserved areas of Kentucky where the lack of adequate care facilities has hampered the delivery of primary care, leading to adverse outcomes. Primary care remains vital for such vulnerable, underserved populations in rural Kentucky.
Description of the Walk-in Center
To enhance accessibility to primary healthcare in rural Kentucky, novel models of primary healthcare are necessary, which can also bolster the role of nursing in facilities or regions with staff shortage. A nurse-managed primary healthcare walk-in center is an innovative model for healthcare delivery that has worked effectively in the UK and the US, but not in all regions or states (Desborough, Forrest, & Parker, 2012). According to Desborough et al. (2012), a walk-in center is a care facility not physically co-located with the main hospital, has extended hours of service, and receives patients without an appointment or referral. In some instances, in Australia, for example, walk-in centers are publicly funded and offer free care to patients. Some of these facilities are nurse-managed or general practitioner (GP) led. They may be solely staffed by nurses, GPs, or any other professional practitioners with the necessary qualifications to deliver primary care to patients.
The facility runs on Clinical Decision Support Software (CDSS) to enhance clinical decision-making at the point of care. Nurses are expected to collaborate with the emergency department to handle cases that require urgent care.
Nurse-led and nurse-managed health care
Walk-in centers are nurse-led, family physicians, or GP-led. That is, nurses or general practitioners are instrumental in the development and execution of the model. They make critical decisions on leadership and operations management at these facilities, including staffing, budgeting, referral, communication, and outcome evaluation (Norlander, 2011; Hughes, 2006).
Partnerships and collaboration
In this model, nurses collaborate with the emergency department during a patient referral to ensure care continuity. Additionally, a walk-in center delivers low-cost primary healthcare to patients and, thus, partnership with government agencies and other supporting bodies is vital for the continuity of these facilities.
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Continuity of care across settings
Nurses ensure that patients who require emergency care are referred to the emergency department for physicians. Clinical data are also expected at various points of care. Additionally, nurses coordinate aspects of communications when patients are moved to a different setting to ensure that patients’ needs are consistently met.
In addition to CDSS, the walk-in facility also captures patient administrative and clinical data. A system that can be used by nurses or GPs beyond the normal service hours is deployed (Gnani et al., 2013). Patient data collected after services are integrated into the regular electronic health record system of the hospital.
Development/Implementation Team for the Walk-in Center Model
Notably, a walk-in center is nurse-led. As such, nurse practitioners, registered nurses, family physicians, and other healthcare support staff, including translators, implement the model. It is expected that effective communication and collaboration among all stakeholders result in a successful model during and after the implementation.
Evaluation of Walk-in Center: Outcome Measurement
Available evidence suggests that a walk-in center model is evaluated from multiple perspectives. First, the center must demonstrate the use of technologies to capture both administrative and clinical patient data, as well as seamless integration of data across various departments (Parker, Desborough, & Forrest, 2012). Second, the model is also assessed based on the scope of the practice of nurses needed to deliver quality primary care to patients. Third, this model is also evaluated based on its effectiveness on the quality of care. Fourth, the cost of care is also assessed as an outcome measurement for a walk-in center. It is expected that most services should be free or at extremely low costs to the public. Fifth, it is also imperative to assess relationships between a walk-in center and an emergency department; a walk-in center and patients; and a walk-in center and community perceptions. Sixth, staff education and training programs should be assessed, and the possible impacts of introducing a doctor to enhance collaboration, mentorship, and referral. The model remains a nurse-managed initiative. Finally, outcome measurement should also include impacts of this model on primary care in rural areas of Kentucky.
Overall, a nurse-led walk-in center is considered among some of the most innovative models proposed and implemented by nurses to improve the quality of primary care, especially among underserved communities across both urban and rural settings.
Desborough, J., Forrest, L., & Parker, R. (2012). Nurse-led primary healthcare walk-in centres: An integrative literature review. Journal of Advanced Nursing, 68(2), 248–263. Web.
Gnani, S., Ramzan, F., Ladbrooke, T., Millington, H., Islam, S., Car, J., & Majeed, A. (2013). Evaluation of a general practitioner-led urgent care centre in an urban setting: Description of service model and plan of analysis. Royal Society of Medicine Journal, 4(6), 1-6. Web.
Hughes, F. (2006). Nurses at the forefront of innovation. International Nursing Review, 53, 94-101.
Mason, S., Mountain, G., Turner, J., Arain, M., Revue, E., & Weber, E. J. (2014). Innovations to reduce demand and crowding in emergency care: A review study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 22, 55. Web.
Norlander, L. (Ed.). (2011). Transformational models of nursing across different care settings. Report: The future of nursing: Leading change, advancing health (Appendix G). Washington, DC: National Academy of Sciences, Institute of Medicine.
Parker, R. M., Desborough, J. L., & Forrest, L. E. (2012). Stakeholder perceptions of a nurse led walk-in centre. BMC Health Services Research, 12, 382. Web.