This month, I’ve invited Dr. Heather Barnett of the Care of Patients Experiencing Incarceration (CPEI) Task Force, partnering with GME’s Learning Gateway to share the group’s work on improving care of patients experiencing incarceration. I am very proud of this group’s work for this vulnerable population of patients we see in our hospitals.

 

Byron Joyner, MD, MPA
Vice Dean for GME and DIO

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We are excited to share the efforts that our group has been working on to improve the care of patients in the UW Medicine System experiencing incarceration.

 

Background of the group

Patients incarcerated in King County’s jails are a specifically identified mission population of Harborview Medical Center, but care for this population presents unique challenges. In July 2020, the Housestaff Quality and Safety Committee (HQSC) reviewed a submission to the patient safety network in which a trainee expressed moral distress regarding the care of a patient from King County Jail who left the emergency department against medical advice despite their acute medical emergency due to the use of 4-point forensic restraints. Many residents shared similar experiences of moral distress related to limitations in care for patients experiencing incarceration. Discussions among residents led to the recognition that care for patients experiencing incarceration needed additional attention and focus. To improve care of this patient population while maintaining a safe environment for all, a group of trainees created a designated task force to further investigate current issues and targets for quality improvement.

 

Work so far

Survey of Healthcare workers

We conducted a survey among UW Medicine healthcare staff (including attending physicians, trainee physicians, nurses, therapists, and others) and received over 300 responses. We found that:

• Most healthcare staff did not have any specific training or education related to this patient population.

• Most healthcare staff were interested in further training to address knowledge gaps and improve patient care

• Challenges and issues providing optimal patient care were frequent.

Data Gathering

We engaged key stakeholders to determine current issues, priorities, and goals. The group gained valuable information from a variety of stakeholders.

 

Stakeholders

UWMC Nurse Care Managers HMC ED Charge RN HMC ED Attending Correctional health physician experts, Drs. Lara Strick & Marc Stern King County Jail Medical Director, Dr. Benjamin Saunders Hospital leadership Harborview security Office of Healthcare Equity Physicians and activists at other institutions in San Francisco and Los Angeles Community members who received medical care while incarcerated

Education & Data Sharing

Several educational presentations and discussions were held, and preliminary resources were created:

• In May 2021, the UW HQSC-NURF Health Equity Conference was held focusing on the topic of “Caring for Patients who are Incarcerated.”
• Lara Strick and Marc Stern hosted a 3-hour training and discussion session with interested healthcare staff.
• The Task Force created preliminary training materials, including a one-pager and short video for resident and fellow use.

 

Additional Information

• Please check out our new website! This includes links to our currently available training resources (please note, these resources are undergoing ongoing review and improvement):
  • Caring for Patients Experiencing Incarceration
  • Trainee-produced 35 minute education video
• Read more about the group in the 2021 Annual HOUSE Publication, produced by UW HQSC!
• Law Enforcement Requests Disclosure of Patient Information from UW Medicine.

 

Next Steps

• To optimize educational content, we are excited to partner with GME’s eLearning team, Learning Gateway, to develop and distribute a GME-supported eLearning module for current and future residents, fellows, and (hopefully) other staff.
  • This project will begin development in the Spring of 2023, with an expected 2024 launch
  • We will continue to involve stakeholders, area experts, and anyone interested in supporting the project! Please get in touch!
• Possible long-term goals include evaluation of hospital policies related to care of patients experiencing incarceration and community involvement.

 

How to get involved

If you are interested in being involved in the development of a training module, would like to share thoughts or feedback, or have other ways you would like to be involved, please reach out to our group by email!