Harvard University Health Services Urgent Care will no longer see patients in-person between the hours of 10 p.m. and 8 a.m. beginning June 17, HUHS announced Tuesday.
Students who wish to be seen between those hours can call an urgent care line and speak with a tele-nurse or and must be treated at a local hospital if they require immediate care. HUHS first established its nurse advice line in December 2018.
The line was originally launched to “complement our in-person overnight urgent care services,” HUHS Director Paul J. Barreira wrote in an email to Harvard affiliates and their families Tuesday afternoon. He wrote that the tele-nurse system — which connects callers to a registered nurse — will replace all in-person urgent care visits during nighttime hours.
When calling between 10 p.m. and 8 a.m., the nurse advice line connects students to registered nurses through health services company Citra Health Solutions. Nurses then provide advice ranging from home-care instructions, to future appointments, to emergency room visits.
Barreira wrote that a semester-long pilot of the Citra system has convinced administrators of its viability as an in-person urgent care replacement.
“Our semester-long experience with Citra has proven successful, safe, and effective for our patients,” Barreira wrote.
Under the new system, overnight mental health consultations will not change. Barreira indicated that Citra will connect students seeking mental health services with an HUHS Mental Health On-Call Clinician. In alignment with current procedures, students with mental health emergencies will be sent to Cambridge Hospital.
Senior Director of Nursing and Health Promotion Maria Francesconi said in an interview that the new system allows urgent care services to be more streamlined.
“You never get the middle person where you have to give all this information and wait,” she said.
Francesconi said students have not frequently made use of in-person urgent care services that currently exist, and that many students who do come in person require transportation to an emergency room anyway. She said that overnight urgent care received 227 calls in February 2019, during which 15 people came to HUHS in person and six were ultimately directed to an emergency room.
Barreira and Francesconi said they are confident in the “sophisticated” answers that the tele-nurses provide.
As a prerequisite for working, the nurses must have previously spent five years working in Medical-Surgical Nursing or the Emergency Room, according to Francesconi. Nurses use a computer system to guide their response to patients’ symptoms.
Under the tele-nurse system, conversations with patients are recorded and nurses are required to follow up with students to see how they carried out the advice and how the treatment went.
When students are directed to hospital emergency rooms, Francesconi said the process will remain the same — students may take taxis if their condition permits,
"The ambulance is the insurance piece,” Francesconi said. “There are many situations in which we have facilitated transportation to the emergency room through HUPD. We've given taxis if we can do that. We really try very hard to make a clinical decision about the level of severity of what needs to happen in terms of transportation to the emergency room and that's happening now.”
This is not the first time that HUHS significantly remodeled their overnight services. In 2015, HUHS closed Stillman Infirmary. Stillman Infirmary provided an inpatient space with a limited number of beds to students needing short-term care. The infirmary often serviced intoxicated students who came to HUHS as part of the College’s amnesty policy.
The closing of Stillman Infirmary and the reallocation of resources because of the closing allowed Counseling and Mental Health Services to expand. HUHS was also able to undergo renovations to create a “welcoming” space, according to Francesconi.
Despite the modified hours, Urgent Care will continue to operate 7 days a week, 365 days a year.