When people think of an Urgent Care Clinic they think of minor injuries such as sprained ankles, sore throats and common cold symptoms, and other acute illnesses and injuries not serious enough for a visit to the Emergency Department. The evening of January 12 proved that patients with any type of illness can present to an Urgent Care Clinic.
Around 5pm that evening, the team of Jennifer Simons, ARNP, Rachel Coleman-Thompson, RN and Lori Smith, NA-C, was working in the Cle Elum Urgent Care Clinic. They had just completed the transfer of a septic patient to KVH's ED. That patient required more resources than what was available in the Urgent Care and they quickly arranged appropriate transfer. As one patient was leaving the Urgent Care heading to Ellensburg via ambulance, another patient was arriving at the back door via private auto.
This 72 year old male had become weak, diaphoretic and was experiencing shortness of breath. The team quickly assessed the patient performed a 12-lead ECG and found him to be in third degree heart block with a heart rate in the 20's. His oxygen saturation was low contributing to his shortness of breath and weakness. They immediately began treatment for this life-threatening condition. He was placed on the cardiac monitor and was prepared to be transcutaneous paced if his condition deteriorated. Oxygen was started, IVs quickly placed, and medications taken to the bedside. The patient was awake and alert; however, the staff knew that could change any minute. In addition to the quick and thorough medical care provided, the staff gave emotional support to both the patient and his wife.
Per protocol, the staff immediately called 911 to arrange transfer to Yakima Regional Hospital where the patient had received cardiac care in the past. It was noted that both Cle Elum ambulances were on calls, one heading to Ellensburg with the septic patient and the other in Ellensburg completing a call. An ambulance was dispatched with lights and sirens to the clinic from Ellensburg. In addition, because of the seriousness of this patient's condition, the Urgent Care team requested from dispatch local volunteer firefighters in case more hands were needed to help. They were pleased to have six volunteer firefighters arrive quickly for back-up.
Jennifer was in contact with both the Emergency Department Physician and the Cardiologist on-call in Yakima to review the patient's condition and care being provided while the ambulance was on their way. This patient was in the Urgent Care for a total of 55 minutes. He was transferred to Yakima Regional Hospital where he received a pacemaker and was discharged home in good condition.
The Urgent Care staff took this opportunity for department training after this high risk, low frequency patient care experience. The case was reviewed at a staff meeting of Advanced Practice Clinicians, Registered Nurses and Patient Care Technicians. In addition to reviewing the pathophysiology of this diagnosis and the care of the patient, hands-on training was provided for transcutaneous pacing. Quarterly education will be provided to the staff on similar types of critical patients that may present to the Urgent Care.
Every staff member that works in our Urgent Care Clinic is well trained and prepared to take care of any emergency that walks through those doors. This small staff (and a handful of volunteer firefighters) demonstrated excellent teamwork by providing high quality care the evening of January 12 to a critical patient in a less than optimal setting. They each had an important role and were able to carry it out in a calm manner that resulted in an excellent outcome for their patient.
We are proud that the "Urgent Care Pacesetter's"; Jennifer Simons, Lori Smith and Rachel Coleman-Thompson, are a part of the KVH family.