Island clinic adds staff to better address urgent, primary care needs

Nurse practitioner Katie Konrad will begin seeing patients with acute care needs at Vashon’s Neighborcare clinic next week. (Courtesy Photo)

As the Neighborcare clinic marks its sixth month on Vashon, clinic officials continue to hire a variety of staff for the Sunrise Ridge facility, while they discuss moving to a larger clinic space within the next few years.

In a wide-ranging conversation last week that included everything from staffing matters to the arrival of the X-ray machine, Medical Director Jessica Wesch and Administrator Stephanie Keller said they are continuing to try to meet the health care demands on the island, both for those with established appointments and those who need care on a same-day or urgent basis.

“Our intention is to provide both urgent and primary care in the right way,” Wesch said.

As part of that effort, a new provider, who is familiar to many on the island, will begin next week, and soon a nurse, social worker and referral coordinator are expected to follow.

Nurse practitioner Katie Konrad is slated to begin on Monday and initially will see only those patients with acute care needs. Konrad, who worked for many years at Vashon Plaza Medical Clinic and at the Vashon Women’s Health Center for a short time before it closed, will move into having her own patient load after another provider is hired and in place, ideally by July.

Wesch and Keller said having a designated provider for those with acute needs is important not only for those seeking care, but for the smooth running of the clinic overall. When Neighborcare Health agreed to come to the island, officials promised that the long waits common at the clinic previously would be a thing of the past. While that is the intent, Wesch said that when people arrive with pressing medical needs, providers must respond, and waits often ensue.

“We have an obligation to care for those that are potentially critically ill,” Wesch added.

Additionally, Wesch noted that while the clinic is intended for primary care, many islanders try to use it when they need to be seen in an emergency room, such as for concussions, chest pain and some broken bones. She added that the clinic does not have the equipment or the trained staff of an emergency room, and while clinic providers can facilitate emergency care, they cannot provide it themselves.

In another significant change, Neighborcare is hiring a social worker, who will provide case management and help link patients to services on or off the island for such issues as grief and loss, substance abuse and depression. During a regular medical appointment, the provider can invite the social worker in to assist. Called embedded behavioral health, it is a very effective model of care, Wesch said.

Also on the hiring roster are a new nurse and a referral coordinator.

Administrator Keller, who began two months ago — a human resources specialist who previously worked at the University of Washington Division of Gastroenterology, — said she has been focused on getting the clinic staffed up. Support staff has been easy to hire, she said, but providers have been more challenging to bring on. She noted that she would encourage nurse practitioners or physicians assistants living on the island to apply.

“It is just a five-minute commute,” she joked, providing an enticement.

Additionally, she said the clinic has fielded many complaints about its inability to meet acute care needs, and addressing access-to-care issues has been her top priority.

“Once we are able to meet same-day demand, that will help,” she said.

It is not just patients with urgent medical needs, however, that have added to the challenges of meeting the demand for care, but registering new patients — which requires 30-minute appointments — also takes time. So far, 2,500 patients have registered, but the process is ongoing.

“If we estimate that there are 7,000 to 10,000 patients, and we do the math with each patient requiring 30 minutes, it will take well over a year,” Wesch said.

Once established, patients must continue to receive care and while some appointments are short and straight forward, a large number of patients are elderly with complicated medical needs and require multiple visits. Some 44 percent of the clinic population is covered by Medicare, she noted.

The staffing goal to effectively meet all the need is to have seven providers on staff, with two dedicated to seeing walk-in patients and those needing urgent care — a challenge in the current site.

“That will put us literally almost on top of each other,” Wesch said. “We need a new building that has the capacity to meet island needs and is designed for efficient work flow.”

Currently, Keller said, staff have been looking at how to reconfigure the current space; offices might become exam rooms, and storage rooms might become offices.

Wesch indicated they are considering the changes thoughtfully.

“We have to look at the cost analysis of doing this. Doing any upgrades is costly, and we are on a bare bones budget,” she added.

She noted that they would like to be in a new building within two to three years and stressed that any decision would be a community decision.

Keller concurred.

“We are looking at options. It is a large undertaking, and we want to be thoughtful and thorough,” she said. “It is going to take a lot of time and discussion.”

A tour of the clinic revealed some of the issues and plans in place to address them: tight work spaces, tape on the floor of a store room showing where desks might fit in and an area soon to be designated for acute care. The tour also provided a look at the new X-ray machine.

Wesch said it is a state-of-the art, low-radiation digital machine. Staff will take and read the X-rays, which will also be read within 30 minutes by outside radiologists. The X-ray machine will be used for a myriad of needs: fractures, pneumonia and chest pain, among other issues.

Since the clinic opened in September, providers have been sending patients off-island when X-rays have been needed. That process has been cumbersome, Wesch said, not just for the patients, but for the providers as well, who have not always received the results in a timely way. Staff will begin using the new machine on April 1.

Looking ahead, a possible plan in the works is for a clinic based at the high school. Mary Schilder, Neighborcare’s director of marketing communications, said it would be funded by a King County Best Starts for Kids grant, but she noted the grant is expected to be highly competitive — and that it is very early in the process.

“We had our first meeting with the school district, and we are optimistic for this potential partnership,” she said.