DESC Emergency Shelter Primary Care Clinic

Grantee: Downtown Emergency Service Center
Timeframe: July 2016 – June 2019 | Total Amount: $524,558

Year 1: July 2016 – June 2017. Amount: $170,000
Year 2: July 2017 – June 2018. Amount: $169,558
Year 3: July 2018 – June 2019. Amount: $185,000

The goal of the Emergency Shelter Primary Care Clinic is to provide a health home for DESC clients who would otherwise not have access to immediate services, except for a costly and probably unnecessary visit to the emergency room. Since 1985, one full-time RN employed by Harborview Medical Center through its affiliated Pioneer Square Clinic has been sited at the shelter. Harborview’s investment includes the position’s salary and benefits, as well as consumable supplies (disposable gloves, scissors, needles, bandages, blood glucose test strips, etc.). With the rapid growth in Seattle’s homeless population in recent years, it has become clear that one person alone is unable to meet all the needs for immediate/emergent care for the volume of people that seek refuge at and help from the shelter every day. In addition, existing public health resources in the vicinity of the main shelter (Harborview and Pioneer Square Clinic) are at capacity. This project will add an ARNP and medical assistant employed by Harborview (each at  0.60 FTE) to be sited at the shelter and will more than double DESC’s current capacity to meet clients’ primary care needs, extend their capability to include prescriptions written on-site, and allow for higher-level nursing care than is currently provided.

DESC and Harborview determined that expanding their already-successful partnership was the most efficient and cost-effective way to address the human resources infrastructure, medical supervision capacity and data expertise needed to achieve the outcomes for this program. Therefore, DESC will subcontract a large portion of grant funds to Harborview.

The ARNP will serve as clients’ primary care provider, whether they stay at the shelter for a night, a month or an extended period of time. Services provided by the ARNP will include: physical exams; chronic disease management; vaccinations; foot, skin and wound care, and dressing changes as needed; preparation of care and treatment plans; PTSD intervention; infection response and control; prescriptions and medication management; domestic violence injury assessments; referrals as necessary for diagnostic testing or more complex care; client health data entry, monitoring and analysis; and medical case management integrated with DESC’s existing array of mental, behavioral and support programs. The ARNP will be supervised by Pioneer Square Clinic staff and Downtown Homeless Programs.

The medical assistant will support both the current RN and the new ARNP. This position will help shelter staff with appointment scheduling and making sure that clients are present at their appointment time. They will also administer basic health assessments and screening tools; take vital signs; prepare clients for the ARNP/RN exam; enter health data; and ensure that biohazards are appropriately handled. The position will be supervised by the ARNP.