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"Day in the life" features a closer look into staff members' perspectives and work on-the-ground.
8:00 AM: It’s Thursday. In a small office on the second floor of our Fallsway clinic, Kayla Zabkowski logs in and filters through emails and voicemails from the evening before. Kayla is a Registered Nurse and works in the call center three days a week.
“I add notes from each voicemail into the client’s electronic health record and then call them back when it’s a reasonable hour. I try to be as thorough as possible up front—calling the pharmacy, looking at a hospital note—so that nurse practitioners and doctors have all the information available.”
9:35 AM: In a voicemail from earlier this morning, a woman asks about getting supplements without a co-pay at the pharmacy. Kayla pulls the results of her bloodwork (this client recently had surgery, and her blood count showed that she was anemic and iron deficient), updates the client’s chart and forwards to her doctor—who within minutes reviews and prescribes the supplements.
She calls and leaves a message with the update. “You and I talked yesterday about supplements you needed,” Kayla says, “I wanted to let you know they were ordered, and your doctor had another question. Please call me back.”
9:39 AM: A new call center note comes through. A client is asking for Ambien, a sleep medication and controlled substance, that he’d been previously prescribed. “As a nurse, I can give basic medical advice, but can’t prescribe refills,” Kayla explains.
She hops on the phone to get more details from the client. “I got a note you called about getting Ambien refilled,” she says. “So, this is a tricky one, because the doctor you used to see is gone.”
“I’d like it today. I haven’t slept since Friday,” the client explains.
“I’ll ask them and will call you back. But as a heads up, you might need to come into the clinic to see someone before we can order a refill.”
Kayla sends the request to the nurse practitioner’s inbox, along with background information the client provided about how he normally uses the medication.
10:10 AM: After a few more calls, good news arrives and Kayla jumps back on the phone. “Surprise! We were able to send in your refill request for Ambien. I also put in a request for you to get an appointment with a new provider. So just keep an eye out for a call.”
10:16 AM: Time for following up with clients who were recently discharged from the hospital. Kayla logs into CRISP (the Chesapeake Regional Information System for Patients). In short, it’s a database that hospitals and community health centers share to provide better continuity of care. In CRISP, Kayla can see weekly lists of Health Care for the Homeless clients who were hospitalized. The system includes when and why, as well as where they went after discharge.
“I go down the diagnoses in CRISP. If someone was in for a heart attack, stroke or respiratory failure, I call and put an offer out there for a visit.”
“It’s important to do the outreach, especially for clients who may need extra support,” Kayla explains. “Clients often have their medicines changed in the hospital or are on med adherence here (where we manage their pill boxes for them). It’s good to support clients in understanding what the pills are for, what they’re taking and why, so they have control over their health. Avoiding rehospitalization is the ultimate goal.”
10:26 AM: In CRISP, Kayla sees someone was admitted to Johns Hopkins for an overdose. She calls to follow up, but the phone is out of service. Another person was hospitalized for pneumonia. No answer, she’ll call back. She fields a call about a medication refill and then continues calling recently hospitalized clients and adding discharge summaries into their charts.
10:55 AM: The phone rings.
“English or Español? Un momento, necesito un intérprete.” She calls the interpreter line and merges the call. Through the interpreter, the client says, “I’m calling because they told me if I didn’t receive a call with results that I should call back.” “It looks like you had a urinary tract infection, but the meds we gave should have been effective,” Kayla says looking at her records. “Are you feeling better?”
The client says yes and asks about a colonoscopy referral and a physical. Kayla schedules her for a physical on the spot. “If anything else comes up in the meantime, you can come into the clinic during our walk-in hours.”
11:25 AM: Kayla responds to more voicemails and calls. One client needs suboxone, but the proper dose isn’t available at the pharmacy where we sent the prescription. Kayla sends a message to the client's medical providers with the update.
Another client needs medication refills. From his chart, Kayla sees he already has them prescribed and just needs to call the pharmacy directly. She lets other call center staff know. “I try to increase access to care by reminding clients that they have the option to call the pharmacy—they have some agency and power over their own health care, too.”
1:30 PM: On Mondays and Tuesdays, Kayla works in triage—seeing individuals and families who walk-in for care without appointments. She goes to a clinic meeting with six other triage nurses to talk through what’s going well, to identify recent trends and problem solve any complaints.
2:30 PM: Back at the desk, she scans through the hospital data again. Kayla reaches out to around 20 clients on the list each day. “I like digging through the database and trying to piece together a client's health story so they get the care they need.” She calls the interpreter line and asks them to initiate a call with a Spanish-speaking client who had his appendix removed a few weeks ago.
On the phone, he tells her he’s developed a fever but, due to the language barrier, wasn’t sure how to call the surgeon to tell him. Kayla immediately calls the hospital on his behalf and is able to move his post-op appointment sooner to rule out any infection.
4:30 PM: Kayla gets ready to head home. Anyone calling our main number after 5pm will get the automated option to leave a message or get routed to after-hours support for urgent medical or behavioral health care. In the morning, the call center staff will screen for medical questions for Kayla to respond to anew.
“Before the call center system, clients would call and get routed to whoever they asked for,” Kayla says. “Providers’ entire days are booked with appointments, and they couldn’t get to their voicemails. We didn't have a good mechanism for responding to emergencies. Having this role – someone on the medical team dedicated specifically to clients calling with requests and concerns—we’re able to get in touch quickly, answer questions and support the rest of the team, too.”
Join Our Team for a Great New Year! This December, we’re offering hiring bonuses for full-time and part-time frontline positions in our clinics.
As 2023 winds down and we enter the holiday season, Health Care for the Homeless is facing financial challenges. I’d like to share those challenges with you, as well as the steps we’re taking to make sure we’re here long-term for clients, staff and community.
The first Saturday in November was sunny and cool – a perfect day for 300+ runners, walkers, friends and volunteers to gather at Patterson Park for the 10th annual Rock Your Socks 5K! We danced, cheered and enjoyed a festive race village complete with coffee, donuts, tie-dye, a bounce house and easy ways to engage with community partners.