A Commitment to After Hours Care

At the Child and Adolescent Clinic in Longview, providing after hours care is key to providing excellent care. For more than 25 years, the clinic has provided evening and weekend care.

What are the elements that make it successful?
  • A culture of just-in-time care. All 63 staff members at the CAC know that they could be called upon to provide care in the evenings and weekends. Some work evenings regularly as their lifestyle dictates, others rotate through a schedule. Commitment of the staff and providers to expanded care hours is critical.
  • Triage of incoming patients. After hours and weekend, or urgent care, appointments are made same day only and are only booked once the regular clinic day is full. An MA can help front desk staff triage needs that aren’t necessarily urgent- a wart removal, or allergy consult, for instance, can wait until another day.
  • Insurance contract negotiation. CAC has been able to negotiate favorably with insurance providers by demonstrating a decrease in ED visits as a direct result of families having access to the clinic after hours. Keeping a child out of the ED not only spares the family a potentially upsetting hospital visit, but also impacts an insurance or Medicaid contractor’s bottom line.
  • Parent education. It takes some time and ingenuity to get the message to families and caretakers that they should contact the clinic before heading to the ED. Displaying the hours prominently in waiting areas and clinic rooms, including it in patient handouts, and sharing at newborn visits are some of the channels of communication. Educating patients after they’ve been seen in the ED is essential.

Kimberley Robbins, Clinic Administrator at CAC has a few suggestions for clinics looking to expand their hours:

  1. Start with your busiest days. CAC initially offered Saturday hours and first expanded to add Monday and Tuesday hours. The clinic now offers expanded hours Monday through Friday evenings and Saturday and Sunday mornings. They extended their hours as their patient base grew and they added more providers.
  2. Get buy-in from your staff. It might be a big culture change to have everyone committed to extending the 9-5 work day or working a weekend when the rotation comes around to them. Getting all your staff to agree to the mission may be challenging but will result in a stronger team.

Real world application
Jamie (not her real name) is a college student visiting her parents in Longview for the weekend. She had visited her campus health center for a fever and was told it was a virus and would soon go away. When she didn’t feel better she ended up in an urgent care clinic in her college community where she was told again that she had a virus. Jamie made her way into CAC on Sunday before she headed back to school, exhausted and feverish and nervous because volleyball was starting the next week and she felt too sick to play. She was diagnosed with mononucleosis with spleen involvement. Sadly, she won’t get to play volleyball. Without access to CAC she may have finally been diagnosed much later and in the meantime tried to play a contact sport.

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