Maggie McKay (Host): Medical issues don't always happen during business hours. Oftentimes, it's at a very inconvenient time. So luckily, there's the ICHS After Hours Clinic. To tell us more is Dr. Beth Weitensteiner, Site Medical Director at ICHS Holly Park Medical, and Tram Le, Health Center Manager.

Welcome to Together We Rise, a podcast from International Community Health Services. ICHS advocates for health as a human right and welcomes all in need of care, regardless of health, immigration status, or ability to pay. I'm your host, Maggie McKay. Welcome Dr. Weitensteiner and Tram. So good to have you both here.

Dr. Beth Weitensteiner: Thank you.

Tram Le: Thank you.

Host: Let's start with Tram. Why did ICHS launch the Holly Park After Hours Clinic?

Tram Le: Well, as you mentioned, it's to meet the demand of the acute care after the regular operation hours. The story starts with we have a lot of patients walking in around 4:30, 5:00, or calling in with the acute symptom. And during that time, we don't have anything available for patients, and it is hard, it's hard to turn patients away. And also, the goal is to decrease the emergency visits and/or send them to urgent care, because that's where they can go, that's the only two places that they can go, is to emergency and/or to an urgent care, which can be challenging for our patients where the barrier can be transportation, the barrier can be a language and wait time. It can be three, four hours in the emergency and not imagine about the cost that they will receive a bill after getting care at those facilities. And it's also thinking about it's a opportunity for the clinic to provide the care within the community and invite the family to establish the care, to introduce them to the family care that they need to establish the care and get healthier so they don't have to go to the emergency department a lot after.

Host: Boy, isn't that the truth? Last time I went to the emergency room, it was an eight-hour wait. Not where you are, but still it was crazy. Dr. Weitensteiner, what types of illnesses and injuries can a patient receive treatment for there?

Dr. Beth Weitensteiner: So, our after hours clinic is principally focused on acute illnesses, things that happen within the last one to seven days. You're fixing dinner, you cut your finger. You need to go someplace. You have a cold or a cough that is starting to worsen. You test positive for COVID. We can deal with all of those things. And again, as Tram iterated, it helps our patients get easier access without having to rely on our emergency rooms to fulfill those needs at this time and further stressing the healthcare system. We can take care of these things for our patients.

Host: And can you go into a deep dive example of how receiving care at the After Hours Clinic benefited maybe a patient rather than going to an emergency facility?

Dr. Beth Weitensteiner: So, we have lots of parents with little children that end up with nausea and vomiting early on and they don't know what to do. And our colleagues at Seattle Children's in their emergency room certainly can deal with all of these things. But it's a long drive for our patients from South Seattle, all the way up to the University of Washington area.

And so, we had a couple of kids just last week that had gastroenteritis. So, stomach illness with diarrhea and the parents are going like, "What do we do?" And we said, "Come in." Like, you don't have to go all of that way. And we can walk them through supportive care, what they need to do to manage it. We had a patient early on when we first opened the clinic who tested positive for COVID and he was on his way to the emergency room. We said, "No, no, no, no, no, come to our parking lot." We can take care of you here, and still take care of his family, give him quarantine guidelines, give him Paxlovid. So, it's just really a responsive venue for our patients for just acute, urgent needs that happen to all of us.

Host: What a relief for the community. I mean, that's so much more convenient all the way around. Tram, what are some of the challenges you've encountered with running this service since it launched last year?

Tram Le: I can touch base about the operation part and then Dr. Beth can jump in and we got it integrated to the clinical part. For operation, I think hiring is the most challenging part for me as a health center manager, especially hiring for the MA. it's not just for ICHS, but it's a norm in healthcare right now, especially for the community health centers like us. Especially after COVID, I think the demand for healthcare staffing has being tremendous. Looking for MA, we've been continuing to hire, continuing facing with shortage, and the work is there, the need is there, and that is the most challenging, looking for the MA and especially working in the clinic like ours requires people who come in with the passion, understand the need of the patients, understand the culture of the patients to be able to assist the patients. That's the most of the challenge.

The second challenge is working in the neighborhood at the Holly Park, safety is my most concern for the staff and for the patients who come to seek care in the after hours, and especially now we begin to step into the fall and the winter when it will be getting darker. We do have security on site, but with a lot of things going on, a lot of incidents happen around the neighborhood, within nearby the clinic, and some of the incidents happen at the clinic, it is raising my worry for the staff and for the patients who come and get care in the dark.

Dr. Beth Weitensteiner: And from a clinical perspective, I think one of our barriers and challenges that we're trying to work through is the lack of 24-hour pharmacies now inside the city of Seattle and close to Holly Park. Almost all pharmacies close between 6:00 and 7:00 at night. And so, to prescribe something for a patient that could help them right then and there, but if they came in at 8:00, then they're usually waiting for the next day to do it. So, we're trying to look at whether or not our pharmacy, whether it's financially feasible for us to remain open with our pharmacy to help our after hours patients. So, it's something we'll explore in this coming year 2025.

Host: And how does the quality of care during after hours compare to, say, regular business hours? And are there ways for improvement?

Dr. Beth Weitensteiner: So, we're really pleased and honored with all of our providers at Holly Park and all members of our medical team. The quality of medical care that's provided at all ICHS clinics is really high quality. We are a gold medal HRSA quality award winner this past year. And so, the quality doesn't change, just because you come at 5:00 to 9:00, you still get a compassionate and caring provider who is going to deliver culturally and linguistically appropriate care to our patients. We really are fortunate to have just an amazing, outstanding team, front desk to back office, just really an amazing team.

Host: That's so important, right? Tram, what does the community say? What's their response been to the ICHS after hours clinic since you opened?

Tram Le: The clinic is open up to both ICHS and non-ICHS patients, and we are really happy to say that it's well accepted by our community. The clinic is gradually getting busier and busier, and I can say that it's by the word of mouth, more than any advertising. By 5:00, when I go to the waiting lobby, the waiting lobby is already filled with patients who are waiting for the after hour clinic. And by 6:00, the clinic already has 10 patients scheduled. So, we are already in the talking of should we adding another provider for this coming flu season, when we know that the respiratory season is coming during the flu season because now we're talking about the demand during this season.

So, we can tell that it's really accepted by the community and 20% of our patients who are seen during the after hour clinic is our new patients. And out of that 20% of new patients, 50-60% is established care with ICHS afterward. So, it's really a happy news for us because it means that they get the care that they need. We'll be able to take care of them and make themselves and their family healthy.

Host: Dr. Weitensteiner, would you like to add anything?

Dr. Beth Weitensteiner: I just confirm Tram's sense of what our community response is. They come back, and they tell their friends and family, which reinforces that the product, the care that we provide are really helpful to the community. And we are all about taking care of people here at Holly Park.

Host: Well, thank you both so much for sharing this useful information. We appreciate your time.

Dr. Beth Weitensteiner: Thank you.

Host: Again, that's Dr. Beth Weitensteiner and Tram Le. To find out more, please check out our website at ichs.com. And if you found this podcast helpful, please share it on your social channels and look at our entire podcast library for topics of interest to you. I'm Maggie McKay. Thank you for listening to Together We Rise, a podcast from international Community Health Services.