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Transitions in motion for late-night urgent care, Community Care Center

November 8, 2010; updated November 30, 2010

By the end of December, MIT Medical will have completed transitions in the way we provide late-night urgent care as well as the care provided by the Inpatient Unit, which is being replaced by the Community Care Center. Below are some questions and answers about these changes. (Note: some of these questions appeared in an FAQ earlier this year, but they have been revised and updated.)

Late-night urgent care

Community Care Center

Late-night Urgent Care

When will Urgent Care be open for walk-in visits?

Starting Dec. 22, 2010, Urgent Care will be open seven days a week from 7 a.m. to 11 p.m.

What will happen when someone needs help in the middle of the night?

If you or a friend has an urgent medical or emotional problem, call 617-253-4481. A trained triage nurse will speak with you and/or your friend and provide advice on what to do next. For example, the nurse may recommend a next-day appointment or advise you to go to a nearby hospital immediately. Clinical providers are on call overnight, and triage nurses can contact an MIT Medical clinician when necessary. MIT Medical’s Mental Health and Counseling clinicians are always on call and can meet students on campus 24 hours a day.

I’m an undergraduate. Will my parents be notified if I’m sent to the hospital? If I’m on their insurance plan, will they get a bill?

As in the past, the answer to this question depends on the seriousness of the student’s condition.

Non-life-threatening conditions—in cases where students would previously have been admitted to MIT Medical’s Inpatient Unit (e.g., mild intoxication, gastroenteritis, or mononucleosis), we’ve made an arrangement with Mount Auburn Hospital (MAH) whereby students can be admitted for supportive (or “sub-acute”) care. As long as clinicians at MIT Medical and MAH agree that an admission can be classified as sub-acute, it will be covered by the MIT Student Medical Plan, which every student has. In such cases, parents will not be notified and parents’ insurance will not be billed.

Acute conditions—in cases such as alcohol poisoning or appendicitis, emergency room visits and hospital admissions may trigger notification of the parents’ insurance company—but only if the student is additionally covered by his or her parents’ insurance rather than the MIT Student Extended Insurance Plan.

Parental notification is an issue separate from billing. Hospitals have their own policies about when to involve parents but, like MIT Medical, they must follow the federal health information privacy rules known as HIPAA (the Health Insurance Portability and Accountability Act). HIPAA forbids hospitals from sharing information about your medical care with parents, other family members, or anyone else unless you give permission or unless your condition makes you unable to make your own health care decisions. However, we’ve always strongly encouraged sick and hospitalized students to keep parents, housemasters, and living units informed about their situations.

If I can’t obtain care until nighttime because of classes and other commitments during the day, what am I supposed to do? And does this mean that wait times in Urgent Care during the day will be longer?

It’s important to remember that Urgent Care will still be open until 11 p.m. every night of the week, so even if you have commitments during the day, it should be convenient for you to come to MIT Medical in the evening. As far as very-late-night hours, our statistics show that very few patients in recent years have actually visited Urgent Care during this time, whether due to sudden illness or injury or simply for convenience. In 2009, Urgent Care had a total of 17,027 visits, but only 459 of them (2.6 percent) were made between midnight and 7 a.m. That’s about 1.2 visits per night over the course of the year (or 1.7 visits per night from February to May, the busiest months). This is very few compared to the average of 45.4 daytime visits (7 a.m. to midnight) per day during the year.

The shortest wait times in Urgent Care are usually in the morning, so it’s always most time-efficient for patients to visit before about noon whenever possible.

It’s 2 a.m. I just broke up with my girlfriend and I feel like the world is caving in. Is there someone I can talk to?

For any urgent matter like this, you can call 617-253-4481, and a clinician from Mental Health and Counseling will help you sort things out. This is the way it’s always been, and nothing is changing.

When my roommate got really drunk one Saturday night, I just walked her over to Medical. What do I do if this happens again?

If your roommate is nonresponsive and you’re on campus, call 100 from a campus phone right away, and an emergency response team will be sent. If you’re off campus or using a cell phone, call MIT Police at 617-253-1212. (You could also call 911, but the dispatch time will be longer.) If your roommate is responsive, call 617-253-4481 to speak with the triage nurse, who can give you advice on how to handle the situation, depending on your friend’s condition.

What if I’m not fluent in English—are there translation services late at night?

Yes. The medical telephone triage service uses the same language line as MIT Medical clinicians use during the day. If you’d like an interpreter, just ask for one at the beginning of the call.

Community Care Center

What is the role of the nurse care managers in the new Community Care Center?

The nurse care managers in the Community Care Center (C^3) help students and others navigate the health care system. If a patient is hospitalized, a C^3 nurse care manager will visit the hospital or call to connect with the patient, his or her family, and the hospital’s case manager. The C^3 nurse collaborates with the case manager to coordinate post-hospital care and advocates for needed services. C^3 nurses also provide on-site outpatient care at MIT Medical, including intravenous infusions, wound care, and instruction in many self-administered treatments. When appropriate, they can also make "house calls" to sick students in their dorm rooms.

Will the nurse care managers in the Community Care Center have the same level of training as the nurses who previously staffed the Inpatient Unit?

The five nurse care managers are experienced registered nurses who were on the previous Inpatient Unit staff. All have received additional training in care management to prepare for their new roles.

I understand that nurse care managers will make “assessment visits” to sick students in dorms or FSILGs (fraternities, sororities, and independent living groups) if necessary.  For students who have roommates, aren’t dorm visits a violation of privacy? What if I just don’t want anyone from MIT Medical visiting me if I’m sick?

We encourage students to come to MIT Medical to be seen if they are ill. When a student calls MIT Medical and a nurse care manager determines that visiting the sick student in the dorm or FSILG is warranted, that visit will happen only with the patient’s consent. MIT Medical providers make every effort to maintain privacy and confidentiality, regardless of the setting.

Nurse care manager visits are optional. If for any reason you don’t feel comfortable having a nurse care manager visit you in your dorm or FSILG, we strongly encourage you to call or visit MIT Medical, and to stay in touch with your housemaster or residential advisor so MIT Medical’s nurse care managers can work with them to make sure you’re receiving the care you need.

I live in an apartment off-campus. Will the nurses visit me there if I’m sick?

No, we are not able to make visits to non-campus residents. When you’re sick, we can provide advice by phone—and if needed, we encourage you to come in to Urgent Care from 7 a.m. to 11 p.m., or make an appointment with your primary care provider.

I have a medical condition that requires me to get an IV infusion every month. With no Inpatient Unit, can I get this treatment at MIT Medical? What if I’m not enrolled in one of the MIT health plans?

The nurse care managers in the Community Care Center (C^3) will continue to provide on-site care for infusions. If you aren’t covered by an MIT insurance plan, your own insurance may cover infusions at C^3.

Nurse care managers also take care of patients who need observation, post-procedure care and wound care. In addition, they’ll provide patient education and coordinate influenza vaccination clinics and other large-scale community health activities.

What will happen to patients, especially non-students, who need post-operative care? Up until now, patients could often spend a short time in the Inpatient Unit after surgery.

Use of the Inpatient Unit for post-operative care has been declining markedly in recent years. MIT Health Plan members, retirees and students each comprise about one-third of overnight inpatients, and use by all three groups has been declining in parallel.

If you’ve been in the hospital for surgery or an illness, the C^3 nurse care managers will help to make sure you get the follow-up care you need. Depending on your condition, you may go to a rehabilitation facility, or go home with after-care services provided by a visiting nurse, physical therapist, and/or occupational therapist coming to your home. You may be well enough to make visits to community providers for services. We will design an individual plan for each patient.

I live far from campus and need to have a colonoscopy. Last time I had this done, it was terrific to spend the night in the Inpatient Unit. Will I be able to do this again?

No, once the Inpatient Unit is closed for overnight stays, you won’t be able to do this again. However, if you have Medicare or the MIT Choice Plan, you may have your colonoscopy done close to home.

How did you decide to make this transition from the Inpatient Unit to the Community Care Center?

We started by doing a careful review of how patients have used our Inpatient Unit in recent years. Statistical details are available here. We also looked closely at our experiences working with campus partners to coordinate care for sick students during the recent H1N1 pandemic. This review led us to formulate the proposal for the new Community Care Center announced last spring. Then we refined the proposal based on community feedback and suggestions through several avenues (meetings, web form comments, online chats, etc.).

*This news story has not been updated since the date shown. Information contained in this story may be outdated. For current information about MIT Medical’s services, please see relevant areas of the MIT Medical website.